Nerve Blocks

What is a nerve block? 

Nerve blocks use a numbing medication and sometimes a steroid to prevent nerves from sending pain signals to the brain. This is a minimally invasive treatment that is most often used when your pain is unresponsive to other treatments, but it’s not yet time to consider a surgical response. It’s also a good treatment option for people who are not eligible for surgery.

In addition to treating acute pain, pain after surgery, and chronic pain, a nerve block can be used as a diagnostic tool.

If your doctor suspects that pain signals are originating from a certain nerve or group of nerves, they may recommend this procedure. And, if your pain is successfully relieved after this, you might be a good candidate for radiofrequency ablation (a more long-term pain treatment). If the pain is unrelieved, this means that those nerves are not the origin of your pain.

Benefits

There are a variety of nerve blocks that benefit many pain conditions. Some of the conditions treated with a nerve block include:

• Pre- and post-surgical pain
• Phantom limb pain
• Chronic headache
• Migraine
• Joint pain
• Sciatica
• Complex regional pain syndrome

They’re also often used as a treatment option when poor health or other conditions do not allow you to undergo surgery. In other cases, a nerve block can function as a diagnostic tool, confirming a diagnosis or prompting your doctor to look for other causes of your pain.

Research

Regardless of use, there is good support for nerve blocks in the research.

A 2019 study found that peripheral nerve blocks resulted in at least a 50% reduction of pain in the vast majority of study participants with chronic pain. Importantly, these patients also reported an improved quality of life after their nerve block.

For trigeminal neuralgia, a 2018 study reported that all participants were immediately pain-free following the block, and many remained that way for eight months following their block.

The outcomes for hip and knee replacement patients are even more promising. After looking at over a million patients, study authors concluded that patients who used nerve blocks during hip and knee replacements resulted in better outcomes than patients who opted out of this treatment. Complications were fewer, and hospitals stays were either decreased or eliminated entirely.

What are the different types of nerve blocks?

There are different types of procedures that usually correlate to the location of pain in the body. There is one major exception to this in the form of a peripheral nerve block, used in a more widespread manner.

These are the most common types of nerve blocks.

1. Occipital nerve block

Your occipital nerve originates in the cervical spine. Damage or injury to this nerve can cause migraine headaches as well as pain on the sides of your head and around the eyes.

An occipital nerve block, usually administered between the third and fourth vertebrae, can help ease this pain.

2. Genicular nerve block

The genicular nerves are located in the area in and around your knee joint. These nerves send pain signals when the knee joint is damaged, either through injury, trauma, or simple wear and tear. A genicular nerve block treats many different types of pain, including knee pain that occurs after knee surgery.

This type of nerve block is also especially effective for people with chronic knee pain who are not eligible for knee surgery. A genicular nerve block allows you to undergo other treatments like physical therapy to reduce overall pain.

3. Trigeminal nerve blocks

Your trigeminal nerve is located just in front of the ears on both sides of the head. Its branches innervate the skull, forehead, cheeks, nose, and jaw. Damage to the trigeminal nerve is responsible for some of the hardest-to-treat facial pain, often referred to as trigeminal neuralgia.

Pain originating from the trigeminal nerve can be triggered by something as light as a breeze. A trigeminal nerve block can offer relief while underlying causes are explored and treated.

4. Pudendal nerve block

The pudendal nerve begins at the back of the pelvis and then branches out in three directions from the sacrum. One branch innervates the rectum, and the other two bring sensation to the perineum and genitals.

For people experiencing pelvic pain, a pudendal nerve block can help. This pain may be caused by a catch-all condition called pudendal neuralgia, or it can occur due to injury to the region during childbirth or other trauma. Tumors or cysts pressing on this nerve can cause pain as well. A pudendal nerve block may also be administered during surgery to this area of the body.

5. Intercostal nerve block

Intercostal nerves are located in and around the spaces between the ribs. These nerves provide sensation to the entire diaphragm, including your upper chest, belly, muscles, and skin. Pain may be caused by conditions such as a shingles infection or surgery (including mastectomy) and any other post-operative pain.

For many, an intercostal nerve block injection offers relief after just one treatment. This allows the body to heal and recover with less pain.

6. Peripheral nerve block

Peripheral nerves innervate the entire body, allowing for movement, sensation, and motor control. A peripheral nerve block can block pain sensations from a larger region of the body.

Peripheral nerve blocks focus specifically on the nerves responsible for pain in a particular area of the body. The sciatic nerve is a good example of a peripheral nerve. It is the longest and widest nerve in the body, starting at the lumbar spine and traveling all the way across the buttocks, down the hip and leg and ending in the foot. A peripheral nerve block in the sciatic nerve can ease pain and other discomfort.

Peripheral nerve blocks may also be used for surgical procedures. Research indicates that you may recovery more quickly from certain surgeries in the short-term when your anesthesia plan includes a peripheral nerve block.

For chronic pain in the peripheral nerves, your doctor may offer you a continuous catheter nerve block. Instead of a single injection, they’ll place a catheter under the skin next to the affected nerves to deliver continuous medication.

7. Stellate ganglion block

Stellate ganglion nerve blocks diagnose but can also provide pain relief. This nerve group supplies sensation to the head, neck, chest, and arms and can be used to diagnose (and sometimes treat) any pain in the area.

This injection is administered into the stellate ganglion nerve through the front of the neck, just to the side of the voice box.

There are a variety of other nerve blocks, including celiac plexus blocks for stomach pain and brachial plexus blocks for pain the hands, arms, and shoulders.

What can I expect with a nerve block procedure? 

A nerve block procedure is conducted on an outpatient basis. Many people use only a local anesthetic, but if you are feeling anxious about the procedure, talk to your doctor about a mild sedative beforehand. This can be in the form of an oral medication, or you may receive light IV sedation.

When you are comfortable, you will position yourself on the exam table so that the injection site is easy to access. This will vary. For example, a stellate ganglion block is administered in the front of the neck, and the occipital block is performed through the back.

Your doctor will clean and sterilize the site. Regardless of sedation, your doctor administers a local anesthetic to numb the area. You might feel a pinch or a sting initially, but that will quickly go away as the area becomes numb.

Using X-ray guidance, your doctor positions a small needle in the area above the nerve being targeted. They first inject a small amount of contrast dye to make sure the needle is correctly placed. Once the placement is verified, your doctor injects a numbing medication, a steroid, or both, depending on your treatment plan.

You may receive more than one injection, but the entire procedure takes well under an hour.

Nerve block procedure recovery

After your nerve block, you will move to a recovery area to rest for a short period of time. If you did not receive IV sedation, this period is usually between 15 and 30 minutes.

If you received IV sedation, you are required to get a ride home from your procedure, but it’s a good idea to arrange that regardless.

Take the day off after your procedure. Your doctor will give you specific nerve block recovery instructions, but here are some general guidelines:

• Rest on the day of your nerve block procedure
• Resume regular activity as you feel able the following day
• Take all regular medications unless otherwise directed by your doctor
• Eat a normal diet

You may have some soreness and bruising at the injection site. Non-steroidal anti-inflammatory drugs (NSAIDs) can help with both. An ice pack can also provide comfort and ease both swelling and pain.

Nerve block side effects

Nerve blocks of all kinds are minimally invasive and generally recognized as safe. As with all medical procedures, there is the risk of side effects.

Potential nerve block side effects include:

• Bleeding
• Injury to the nerve
• Muscle weakness
• Increase in pain
• Spinal headache
• Infection

These side effects and risks are minimized when the block is performed under X-ray (fluoroscopic) guidance. Following your doctor’s instructions for nerve block recovery can also help ensure few, if any, complications.

If you experience a sharp, sustained increase in pain, or you experience signs of infection at the site of the block, call your doctor for guidance.

Nerve block pros and cons

These procedures are minimally invasive and can help you reduce the need for surgery. Most people have few, if any, side effects. Side effects that do occur are usually brief and mild. And many people experience long-term pain relief after just one block.

But not everyone responds positively. Relief may only last for hours, or it may not happen at all. Some people need multiple injections over many different nerve sites (especially those who have had chronic pain for more than ten years).

Additionally, if your nerve blocks include a steroid, there are limits to how often you can receive an injection (usually no more than four times per year).

Talk to your doctor about all of the nerve block pros and cons.

What to do if a nerve block does not work

It can be hard to accept this, but if this procedure does not work, that could also be good news.

When a nerve block is used as a diagnostic tool, no pain relief means that the targeted nerve is not the cause of your pain. If this happens, you and your doctor will discuss your next steps towards a diagnosis.

How long does a nerve block last?

Every person in pain is an individual. Because of this, the effects of a nerve block vary. For most people, pain relief occurs immediately after the first nerve block, with a return to pain after the local anesthetic wears off (no more than 24 hours after the nerve block). This is normal and to be expected.

After the local anesthetic wears off, you may feel pain relief in the next few days. A nerve block is considered successful when your pain is reduced by at least 50%, and it can take up to two weeks to achieve that mark.

As for how long pain relief lasts, that, too, depends on the person receiving the block.

Some patients find relief for just a few hours; others are close to pain-free for months. Talk to your doctor about what you can expect given the underlying cause of your pain and any other conditions you have.

Toward a life with less pain 

A successful nerve block (or diagnosis) can help you move toward a life with less pain. Using this treatment option, your pain doctor can begin to implement other pain-relieving tools like radiofrequency ablation for more long-term relief.