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
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: 10-15 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!
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! http:///en/vide-outpatient-catheter-therapy 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.
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 30-60 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.
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) 613-593-4683 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 2338. Administrative crdinatr: Jennifer Brup 613-737-7600 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) 737-7600, and ask the receptinist t page the Anesthesilgy resident n-call.