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What is a peripheral nerve block?
What is a continuous nerve block?
How long will it last?
What happens when it wears off?
Are there any side effects from continuous nerve blocks?
Taking care of your child at home
This nerve block is a way to treat and prevent pain after surgery. Your child’s anesthesiologist injects medication near nerves supplying the area where your child or teen has had surgery. This numbing medication (or local anesthetic) ‘freezes’ the area.
Anesthesiologists use nerve blocks to:
This kind of nerve block allows your child or teen to receive numbing medication continuously. It will help control your child or teen’s pain over the next few days. The anesthesiologist inserts a small tube (catheter) near the nerve. We are then able to give the medication through this tube with a special infusion pump.
Before your child or teen goes home, the anesthesiologist will connect the catheter to a small pump filled with freezing medication. We will give you separate instructions on how to make sure your child or teen is getting the right amount of the medication through the nerve catheter.
The numbing medication (ropivacaine) is long acting. It will control your child or teen’s pain for 6-18 hours after a single injection. Continuous nerve blocks last as long as the numbing medication is infusing through the pump. Your anesthesiologist will decide how long your child or teen will need the continuous nerve block. The numbing medication will keep working for 6-18 hours after the continuous nerve block is stopped.
The pump starts delivering medication once it is connected to your child or teen’s catheter. It continues delivering it until it is empty or disconnected. The special pump is designed to give “numbing” medication for 48 hours.
Your child will be visited by the pain team if they are admitted to hospital. If they are discharged home, you will receive a daily phone call for follow up. Your child will be visited by the pain team if they are admitted to hospital. If they are discharged home, you will receive a daily phone call for follow up.
Your child will be able to move her limb normally after 6-18 hours after the continuous nerve block infusion stops. The feeling in the limb will also come back. To prevent pain, give your child or teen pain medication before the nerve block begins to wear off completely. It’s easier to control pain when you give the pain medication earlier.
Even if the nerve block is working, you may need to add pain medication. You may need to give your child or teen medication for pain if the pain score is more than 4 (on a scale of 0-10, where 0 means no pain and 10 means the worst pain possible).
Pain medicines come in different concentrations (the number of mg of medicine in each mL, tablet or suppository). The amount you give depends on your child’s weight. Check the concentration on the bottle, and read the package directions carefully.
You may need to give these medications for pain, even before the block wears off. These medications will help to control pain when the nerve block wears off completely. Make sure to give these medications at bedtime to manage the pain as the nerve block may wear off during the night.
Your doctor will check off which medications to give your child or youth. As soon as your child or teen is able to drink fluids, give:
Dose: 10-15 mg/kg every 6 hours for the next 48 hours . After the first 48 hours, give acetaminophen only when needed. No more than 4 doses in 24 hours (or 8 doses in 48 hours). My child's weight:
My child's dose:
Dose: 10 mg/kg every 6 hours for 48 hours. After the first 48 hours, give ibuprofen only when needed. No more than 4 doses in 24 hours (or 8 doses in 48 hours). Give ibuprofen with food to prevent stomach irritation.
My child's weight:
My child's dose:
It is normal to feel numbness and heaviness in the affected area. Your child or teen may have difficulty moving this area.
Clamp the catheter and call the Anesthesiology/Pain Medicine Team if your child or teen has any of these side effects.
We will call you at home the day after discharge from CHEO to see how your child or youth is doing. Because your child or teen can’t feel the frozen limb, you’ll need to take special care:
Watch for constipation: it may be a good idea to give children or youth Restorolax®, Miralax® or Lax-a-Day® while they are taking opioid pain medication. You won’t need a prescription, but you may need to ask the pharmacist for these. Follow the instructions carefully. If your child or teen weighs more than 50 kg, give the adult dose once a day.
Check the nerve block injection site each day for the next 2 days. Call your anesthesiologist if you notice signs of infection (this is rare) like:
If your child or teen’s pain is not under control, check the tubing for closed clamps or kinks. Also check to make sure there is medication in the pump.
Bathing Your child or teen will not be able to have a shower or tub bath while the catheter is in place. A sponge bath is OK.
Activity Follow your surgeon's activity restrictions.
Please see the instruction manual on how to check infusion status. Don’t drop the pump, and keep it out of water. If your child or teen is using ice for comfort, keep it way from the lower part of the pump tubing.
If your anesthesiologist decides that your child or teen will need the medication infusion for longer than 48 hours, you may have to return to CHEO for a pump replacement.
You will remove the dressing and catheter at home. The anesthesiologist will tell you when to do this. Any remaining numbness your child or teen has been feeling should go away within 24 hours after the catheter is removed.
If you feel resistance as you pull the catheter, or if the catheter stretches, stop. You could break the catheter if you keep pulling. Wait 30-60 minutes and try again. If you have trouble removing catheter when you try again, call us.
Hold pressure over the site for one minute with a sterile gauze pad. Then apply a band-aid. You may remove the band-aid later that day.
We will call you every day that you are using the pump. We’ll also call you the day after you remove it. We will check on your pain control and discuss any questions or concerns. You can also call us If you have any questions or problems with the nerve block or infusion.
Call right away and clamp the tubing if your child or teen has: • ringing (buzzing) in the ears • numbness and tingling around the mouth • metallic taste in the mouth • lightheadedness or dizziness • blurred or double vision • nausea or vomiting, drowsiness • increased anxiety, shortness of breath, shakes or tremors • signs of infection, like: redness, swelling, pain or discharge at the catheter insertion site where the tubing enters the skin. • abnormal, intense pain at the surgical site or anywhere else on the blocked limb — this is most often a sign that the nerve block is not working and in very rare cases, it could be a sign of nerve damage • limb is still numb longer than 24 hours after a single shot block or after removal of a continuous catheter (suggesting the block is not wearing off).
Call CHEO locating at 613-737-7600 and ask for the anesthesiology resident to be paged. This is the contact for the first 72 hours. After 72 hours, please contact the Ortho clinic (C4) at ext 2338.
MyChart is a FREE secure, online patient portal that connects patients to parts of their CHEO electronic health record, anywhere, at any time.
To apply for MyChart access, visit cheo.on.ca/mychart and fill out the MyChart access request form. Once your application has been approved, we'll send you an email with an activation code and instructions on how to log in and get started.
This reference is for educational purposes only. If you have any questions, ask your health-care provider.
CHEO 401 Smyth Road Ottawa ON K1H 8L1 Phone: 613-737-7600 Email Us
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