A nerve block, also known as regional anesthesia, manages pain before, during, and after shoulder surgery. This procedure targets the nerves that transmit pain signals from the shoulder to the brain, providing localized pain relief. The primary goal is to improve comfort immediately after surgery, which reduces the need for strong systemic pain medications, such as opioids. By minimizing initial pain, a nerve block allows a smoother transition into recovery and facilitates earlier participation in physical therapy.
Understanding Nerve Blocks for Shoulder Surgery
A nerve block involves injecting a local anesthetic near a specific group of nerves to temporarily interrupt their ability to send signals. For shoulder surgery, the target is the brachial plexus, a network of nerves originating in the neck that controls movement and sensation for the entire arm. Blocking these nerves prevents pain signals from the surgical site, often allowing for a lighter general anesthetic during the procedure.
The most common blocks used are the interscalene block and the supraclavicular block, both targeting the brachial plexus high in the neck. The interscalene block is the most common choice for shoulder surgery, though the specific type depends on the procedure and patient anatomy.
Blocks are administered as either a single-shot or a continuous block. A single-shot block is a one-time injection providing pain relief for 12 to 24 hours, often used for outpatient surgeries. A continuous nerve block involves placing a catheter near the nerve bundle, connected to a pump that delivers medication continuously for two to three days. Continuous blocks are reserved for procedures where higher pain levels are anticipated.
The Nerve Block Procedure
The nerve block is typically administered in a pre-operative holding area, where anesthesia providers monitor your heart rate, blood pressure, and oxygen levels. You will be positioned comfortably on your back with your head turned away from the shoulder receiving the block.
The provider cleans the injection site, usually near the neck or collarbone, and numbs the skin with a small injection. A handheld ultrasound machine is used to visualize the nerves and surrounding structures. This ensures the precise and safe placement of the block needle and allows the provider to watch the medication spread in real-time.
You may receive a mild sedative to help you relax, though you will remain awake. As the main needle is advanced, you might feel a brief pinch followed by pressure or warmth as the medication is injected. The entire process may take up to 20 minutes before you are moved to the operating room.
Immediate Effects and Expected Duration
Once the anesthetic takes effect, you will experience profound heaviness and numbness in the entire arm, often described as “dead weight.” This is normal, as the block temporarily prevents both sensory and motor signals from traveling through the nerves. You will not be able to move your shoulder, arm, or hand, and your ability to sense temperature will be diminished.
The duration of complete numbness varies, but a single-shot block typically provides pain relief lasting 8 to 24 hours, sometimes up to 48 hours. Since you cannot feel or control your arm, protecting the limb from injury is extremely important while the block is working. You must wear the sling as instructed to support the arm’s weight and maintain the correct position.
Avoid heat sources, such as heating pads, and extreme cold, including ice packs, since you cannot feel if your skin is being damaged. The loss of sensation can also affect your balance, so having a supportive person at home is recommended to prevent falls. Nurses may check your ability to move your fingers to monitor the block’s effectiveness.
Managing Pain After the Block Wears Off
As the nerve block fades, sensation gradually returns, often starting with tingling or “pins and needles.” This is the ideal time to begin taking your prescribed oral pain medication. It is crucial to stay ahead of the pain by taking medication before the numbness completely disappears, rather than waiting for severe post-surgical pain to set in.
Your recovery plan includes nonsteroidal anti-inflammatory drugs (NSAIDs) and possibly oral opioid medication. These should be timed to be fully active in your system as the block wears off. Taking pain relief medication before bed on the first night is important to prevent waking up to sudden, intense pain. The transition is managed using ice packs, elevation, and prescribed pain relievers.
You should contact your healthcare provider immediately if you experience warning signs that may indicate a complication:
- Persistent numbness or weakness in the arm lasting longer than 24 to 48 hours after the expected duration of the block.
- Signs of infection at the injection site, such as increasing redness, warmth, or discharge.
- Intense, uncontrolled pain that does not respond to the prescribed oral medication.