Treatments

14. Peripheral Nerve blocks

Objective: Peripheral nerve blocks have multiple uses. In this office, we use them to treat: 1) neuralgic pain caused by injury, trauma, surgery, or disease that affects the peripheral nervous system, and 2) nerve pain caused by cancer.

Nerve blocks alter the way nerves transmit painful signals, and are a form of neuromodulation. Nerve blocks can be short- or longterm. Techniques include:

Local anesthetic peripheral nerve injection: This technique might not last as long as other peripheral nerve blocks, but it can help us diagnose the cause of your pain. Our goal is to expose a maximum area of the nerve to local anaesthetic.

The block usually addresses an area between the source of the nerve injury, and the connection to the spinal cord. When repeated several times, some patients notice a significant reduction in their neuralgic pain. This may be due to some form of neuromodulation to the dorsal horn on the spinal cord.

Local anesthetic peripheral neuroma injection: If a nerve becomes severed (say through trauma, surgery, or amputation), it tries to reconnect with the other severed end without success. The result is a benign nerve growth (neuroma), which resembles the shape of a broccoli flower.

Neuromas are sensitive to direct pressure, and fire electrically in a random pattern. The application of local anesthetic can reduce the resulting pain.

Radiofrequency techniques (RF): In this technique, we heat up the peripheral nerve in question through the application of a high frequency electrical signal.

Classic RF lesioning heats the nerve to 80 degrees Celsius for 60 - 90 seconds, causing nerve coagulation and disruption (rhizotomy). The result is permanent interruption of the pain signal (neuromodulation).

Pulsed radiofrequency (PRF) gently warms the nerve to 42 degrees Celsius for 10 -15 minutes. This technique keeps the nerve intact, while neuromodulating your pain.

Neurolytic peripheral nerve injection: This technique is usually reserved for patients with terminal conditions such as cancer, and who are close to the end of their life.

We apply nerve destructive substances such as phenol or absolute alcohol directly to the affected nerves. This neurolytic solution causes coagulation of the vasa nervorum (small vessels supplying the nerves). As a result, the nerve ceases functioning.

The effect can last 6-8 weeks, and needs to be timed carefully, as a chemical neuritis can develop which might be difficult to treat.

If the nerve is easily accessible, the block can usually be repeated. 

Anatomy and Indications

The table below lists indications for different nerve blocks in the body.

Region

Nerve

Diagram

Indications

Head

Greater Occipital

Occipital Neuralgia, Shingles

Supratrochlear, Supraorbital, Infraorbital

Facial Neuralgia, Shingles

Gasserian Ganglion

Trigeminal Neuralgia, Shingles, Facial Cancers

Maxillary, Mandibular

Trigeminal Neuralgia, Shingles, Facial Cancers

Neck

Superficial Cervical Plexus

After Neck Surgery, Trauma

Deep Cervical Plexus

After Neck Surgery, Trauma

Shoulder

Suprascapular

Chronic Shoulder Joint Arthritis

Arm

Brachial Plexus

Interscalene Approach

Brachial Plexus Injuries, Upper Limb Injuries, Pancoast Lung Cancer

Supraclavicular Approach

Infraclavicular Approach

Axillary Approach

Elbow

Median, Radial

Forearm and Hand Trauma, Neuralgia

Ulnar

Forearm and Hand Trauma, Neuralgia

Wrist

Median, Ulnar

Hand Trauma, Neuralgia

Dorsal Radial

Dorsal Radial Neuralgia, Trauma

Hand

Digital

Digital Neuralgia, Trauma

Chest

Intercostal

Intercostal Neuralgia, After Thoracotomy

Abdomen

Intercostal

Intercostal Neuralgia, After Nephrectomy

Intra-operative Pain Relief For Abdominal Surgery

Pelvis

Pudendal

Pudendal Neuralgia, Pain relief for forceps delivery in labour

Groin

Iliohypogastric, Ilioinguinal

After Hernia Surgery

Thigh

Sciatic

Posterior Approach

Sciatic Neuralgia, Buttock, Thigh and Leg Trauma

Anterior Approach

Lateral Approach

Femoral

Femoral Neuralgia, Thigh Trauma

Obturator

Obturator Neuralgia, Pelvic Trauma

Lateral Femoral Cutaneous

Meralgia Paraesthetica

Knee

Common Peroneal, Posterior Tibial

Tibial, Ankle and Foot Trauma

Saphenous

Saphenous Neuralgia, After Varicose Vein Surgery

Ankle

Saphenous, Sural, Posterior Tibial, Superficial Peroneal, Deep Peroneal

Foot Neuralgias and Trauma

Foot

Digital

Mortons Neuroma, Trauma

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