Continuous Nerve Blocks at Home

Transcription

1 What is a peripheral nerve blck? Making a difference in the lives f children, yuth and families Cntinuus Nerve Blcks at Hme This nerve blck is a way t treat and prevent pain after surgery. Yur child s anesthesilgist injects medicatin near nerves supplying the area where yur child r teen has had surgery. This numbing medicatin (r lcal anesthetic) freezes the area. Anesthesilgists use nerve blcks t: Reduce pain after the surgery Decrease the need fr pain medicatins and their side effects (like nausea, vmiting, itching and sleepiness) Allw better rest fllwing surgery Make it easier t take part in physitherapy. What is a cntinuus nerve blck? This kind f nerve blck allws yur child r teen t receive numbing medicatin cntinuusly. It will help cntrl yur child r teen s pain ver the next few days. The anesthesilgist inserts a small tube (catheter) near the nerve. We are then able t give the medicatin thrugh this tube with a special infusin pump. Befre yur child r teen ges hme, the anesthesilgist will cnnect the catheter t a small pump filled with freezing medicatin. We will give yu separate instructins n hw t make sure yur child r teen is getting the right amunt f the medicatin thrugh the nerve catheter. Hw lng will the nerve blck last? The numbing medicatin (rpivacaine) is lng acting. It will cntrl yur child r teen s pain fr 6-18 hurs after a single injectin. Cntinuus nerve blcks last as lng as the numbing medicatin is infusing thrugh the pump. Yur anesthesilgist will decide hw lng yur child r teen will need the cntinuus nerve blck. The numbing medicatin will keep wrking fr 6-18 hurs after the cntinuus nerve blck is stpped. The pump starts delivering medicatin nce it is cnnected t yur child r teen s catheter. It cntinues delivering it until it is empty r discnnected. The special pump is designed t give numbing medicatin fr 48 hurs. CHEO s Pain Service team will assess yur child r teen s pain and can adjust the medicatin as needed. What happens when the nerve blck wears ff? Yur child will be able t mve her limb nrmally after 6-18 hurs after the cntinuus nerve blck infusin stps. The feeling in the limb will als cme back. T prevent pain, give yur child r teen pain medicatin befre the nerve blck begins t wear ff cmpletely. It s easier t cntrl pain when yu give the pain medicatin earlier. Even if the nerve blck is wrking, yu may need t add pain medicatin. Yu may need t give yur child r teen medicatin fr pain if the pain scre is mre than 4 (n a scale f 0-10, where 0 means n pain and 10 means the wrst pain pssible). Frm # P5719E July 2017

2 What happens when we g hme? Yur dctr will check ff which medicatins t give yur child r teen. Pain medicines cme in different cncentratins (the number f mg f medicine in each ml, tablet r suppsitry). The amunt yu give depends n yur child s weight. Check the cncentratin n the bttle, and read the package directins carefully. My child s weight As sn as yur child r teen is able t drink fluids, give: Acetaminphen (Tylenl, Tempra, Panadl, Atasl ) Dse: mg/kg every 6 hurs fr the next 48 hurs. After the first 48 hurs, give acetaminphen nly when needed. N mre than 4 dses in 24 hurs (r 8 dses in 48 hurs). My child s dse: Ibuprfen (Advil, Mtrin ) D nt give t babies under 6 mnths f age. D nt give if yur child is als taking ther nn-steridal anti-inflammatry medicatin (like Celebrex r Vltaren ) Dse: 10 mg/kg every 6 hurs fr 48 hurs. After the first 48 hurs, give ibuprfen nly when needed. N mre than 4 dses in 24 hurs (r 8 dses in 48 hurs). Give ibuprfen with fd t prevent stmach irritatin. My child s dse: If yur dctr has prescribed ther pain medicatins (like mrphine r hydrmrphne), fllw the directins carefully. Give these medicatins nce the feeling in the limb starts t cme back. These medicatins will prevent pain when the nerve blck wears ff cmpletely. Make sure t give these medicatins at bedtime, t prevent pain if the nerve blck wears ff during the night. Are there any side effects frm cntinuus nerve blcks? It is nrmal t feel numbness and heaviness in the affected area. Yur child r teen may have difficulty mving this area. There are 2 types f side effects: 1. Side effects caused by the lcal anesthetic medicatin used. These are rare, but can be serius. They happen when yur child r teen gets t much f the numbing medicatin, causing: Ringing (buzzing) in the ears Numbness and tingling arund the muth Metallic taste in the muth Lightheadedness/ dizziness Blurred visin.! f these side effects. The phne numbers are listed n the last page. Clamp the catheter and call the Acute Pain Service if yur child r teen has any!

3 2. Side effects linked t the numbness the nerve blck causes. These are nt serius and shuld g away when the blck wears ff. Yur child r teen may have weakness in the affected limb. Because the area is numb, it s imprtant t prtect the area frm injury. Yur anesthesilgist will check the kind f nerve blck yur child r teen received (belw), and will give yu any special instructins fr that specific blck. Interscalene nerve blck (neck injectin) may cause: Feeling that yu can t take a full breath Arm weakness Harseness f the vice Drpy eyelid r pinpint pupil n the blcked side Femral blck (grin injectin) may cause: Leg weakness. Remember, this nerve blck des nt freeze the back f the knee, s yur child r teen may feel sme discmfrt there. Ppliteal fssa (sciatic) blck (injectin in the back f the knee r thigh) may cause: Ft weakness Taking care f yur child r teen after a nerve blck Watch the vide! We will call yu at hme the day after discharge frm CHEO t see hw yur child r teen is ding. 1. Because yur child r teen can t feel the frzen limb, yu ll need t take special care: Supprt and prtect the frzen limb at all times. Raising the limb n a pillw may help t reduce pain. Keep the limb in a cmfrtable psitin. Make sure that there is nthing pressing n the frzen limb. Make sure the limb desn t get t ht r t cld. Make sure yur child r teen wears a sling if rdered by yur dctr. 2. Avid excessive activity invlving the frzen limb. Yur child r teen can t feel r cntrl the limb while it s frzen. Take care t avid injury t the area. Yur child r teen wn t have the same sense f feeling in the area, s may nt feel heat, cld r ther things the same way. When getting arund, crutches r a sling may help. Children and yuth shuldn t try t bear weight n a numb leg r use a numb arm fr supprt. 3. Check the nerve blck injectin site each day fr the next 2 days. Call yur anesthesilgist if yu ntice signs f infectin (this is rare) like: Redness; Pain at the injectin site; Swelling; Pus r draining liquid. 4. Watch fr cnstipatin: It may be a gd idea t give children r yuth Restrlax, Miralax r Lax-a-Day while they are taking piid pain medicatin. Yu wn t need a prescriptin, but yu may need t ask the pharmacist fr these. Fllw the instructins carefully. If yur child r teen weighs mre than 50 kg, give the adult dse nce a day.

4 Taking care f the catheter If yur child r teen s pain is nt under cntrl, check the tubing fr clsed clamps r kinks. Als check t make sure there is medicatin in the pump. Dressing: Keep the dressing ver the catheter clean and dry. It is nrmal t have a small amunt f clear r pink-clred drainage under the dressing. Leakage is nt a cncern as lng as pain cntrl is gd. D nt change the dressing. The catheter is nt stitched in place, and culd cme ut if yu remve the dressing. If yu need t, reinfrce the dressing with a large tegaderm. Bathing: Yur child r teen will nt be able t have a shwer r tub bath while the catheter is in place. A spnge bath is OK. Activity: Fllw yur surgen's activity restrictins. Taking care f the infusin pump Please see the instructin manual n hw t check infusin status. Dn t drp the pump, and keep it ut f water. If yur child r teen is using ice fr cmfrt, keep it way frm the lwer part f the pump tubing. This pump: Infuses the nerve blck medicatin. Will be set-up fr yur child r teen after the surgery, befre yu leave the hspital. Will nt allw yu t make any adjustments t it. Gives the numbing medicatin very slwly. It may take mre than 24 hurs befre yu ntice a change in the size r lk f the pump. Will gradually get smaller as the infusin cntinues. It will cllapse as it empties. If yur anesthesilgist decides that yur child r teen will need the medicatin infusin fr lnger than 48 hurs, yu may have t return t CHEO fr a pump replacement. Empty infusin pump Remving the catheter Yu will remve the dressing and catheter at hme. The anesthesilgist will tell yu when t d this. Any remaining numbness yur child r teen has been feeling shuld g away within 24 hurs after the catheter is remved. T remve the catheter: 1. Gently lift the adhesive dressing cvering the catheter insertin site. Yu may als remve any remaining tape. 2. Grasp the catheter as clse as yu can t where it enters the skin and gently pull it ut. This shuldn t cause any discmfrt t yur child r teen. Yu shuldn t ntice any resistance when yu pull. A small amunt f bld r fluid drainage is nrmal. STOP! If yu feel resistance as yu pull the catheter, r if the catheter stretches, stp. Yu culd break the catheter if yu keep pulling. Wait minutes and try again. If yu have truble remving catheter when yu try again, call us as utlined belw. 3. Hld pressure ver the site fr 1minute with a sterile gauze pad. Then apply a band-aid. Yu may remve the band-aid later that day. 4. After remval, check the tip f the catheter fr a black dt. This tells yu that the entire catheter was remved. 5. Wash the skin with alchl swabs t remve any surgical sap r adhesive near the site. 6. Thrw the catheter, tubing and pump in the garbage. D nt try t remve any leftver medicatin. The medicatin des nt cntain any narctic drug. It can t be taken by muth r intravenus (IV) injectin. Peple can have txic reactins if the medicatin is injected int a vein.

5 Fllw up Calls We will call yu every day that yu are using the pump. We ll als call yu the day after yu remve it. We will check n yur pain cntrl and discuss any questins r cncerns. Yu can als call us (infrmatin belw) If yu have any questins r prblems with the nerve blck r infusin. Call right away and clamp the tubing if: 1. Yur child r teen has: Ringing (buzzing) in the ears, Numbness and tingling arund the muth, Metallic taste in the muth, Lightheadedness r dizziness Blurred r duble visin Nausea r vmiting, drwsiness Increased anxiety, shrtness f breath, shakes r tremrs 2. Yur child r teen has signs f infectin, like: redness, swelling, pain r discharge at the catheter insertin site where the tubing enters the skin. 3. Yur child r teen has abnrmal, intense pain at the surgical site r anywhere else n the blcked limb. This is mst ften a sign that the nerve blck is nt wrking. In very rare cases, it culd be a sign f nerve damage. 4. The limb is still numb lnger than 24 hurs after injectin (s the blck is nt wearing ff). Hw t reach us: Office hurs, Mnday t Friday: 7:30 am t 3:30 pm Nurse Practitiner fr Pain: Brenda Martelli (pager) Please cntact Brenda Martelli, fr pain and pump questins during the first 3 days (72 hurs) at hme. After that, please call the rthpedic clinic C4 at ext Administrative crdinatr: Jennifer Brup extensin 2431 Please cntact Jennifer Brup during ffice hurs if yu can t reach the Nurse Practitiner). Outside f ffice hurs (evenings, nights and weekends): Fr pain r pump questins, call (613) , and ask the receptinist t page the Anesthesilgy resident n-call.