Archive October 2014 XV, No. 10

Alternative Uses for Peripheral Nerve Blocks

These innovations show regional anesthesia's not just for surgery.

David Bernard, Senior Associate Editor

BIO

regional anesthesia BUILDING ON BLOCKS In addition to surgical numbing and post-op relief, regional anesthesia can combat chronic conditions.

The benefits of peripheral nerve blocks are well known. Their lasting analgesic effect decreases the need for opioids and their minimal recovery complications all but guarantee patient satisfaction, making them an effective option for numbing the surgical site and managing post-op pain, even in painful joint repair procedures. But that's not all they're good for. Anesthesia providers and pain management practitioners are also placing peripheral nerve blocks to diagnose and treat chronic conditions that trouble their patients. Are you aware of these 4 alternative applications?

1. Shingles
Referrals from primary care physicians and surgeons to the anesthesia providers or other clinicians who run pain management services are perhaps the main route through which patients might receive non-surgical peripheral nerve blocks at your facility.

Pain management doesn't always involve lumbar spine injections for workers' comp injuries. Shingles, a disease sparked by the varicella zoster virus (the same virus responsible for chicken pox), causes a painful rash and in some cases leaves post-herpetic neuralgia, a burning or aching sensation on the affected nerves and skin, for months or years afterwards.

Traditional palliative remedies have included oral narcotic and non-narcotic medications, antidepressants and transdermal lidocaine patches. However, since the shingles rash and subsequent neuralgia often occur along an area of skin served by a particular neural pathway, pain management practitioners have successfully provided patients with relief from the painful aftermath through intercostal nerve blocks. Ultrasound or electrical nerve stimulation can assist providers in determining and reaching the affected nerve roots.

For patients suffering from shingles, pain management practitioners advocate blocking the nerves early, even before the outbreak has subsided, says Pam Wrobleski, CRNA, MPM, DNAP(c), CASC, administrator of the Southwestern Ambulatory Surgery Center in Pittsburgh, Pa. "You don't know who will develop the neuralgia, and they've found success in administering the nerve block early on," she says, noting that it might even ease the outbreak's symptoms as well. "Patients will do better if they're blocked earlier rather than later."

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