News & Updates

Nerve Block Injections: How, Why & Concerns

A “nerve block” is essentially what the name implies. It is a pain management tool used by physicians and other health care providers to block a nerve and thus to block pain, either during or immediately after a surgery. Less commonly, nerve blocks can serve as a diagnostic tool and may be used to figure out the root cause of a patient’s pain or to test a patient’s response to such an injection before proceeding with other long-term treatments.

HOW

Nerve blocks are usually accomplished through relatively simple injections performed on areas of the body wherein nerves bunch together before emanating through a part of the body, such as down a limb or through the back.

WHY

These procedures have become critical in the field of interventional pain management and are often used by physicians specializing in the treatment of chronic pain. The Louisiana State Board of Medical Examiners (LSBME) has advised that when used for the purposes of interventional pain management, it is not the procedures—but the purpose and manner in which such procedures are utilized—that demand the ongoing application of direct and immediate medical judgment, which constitutes the practice of medicine, and which may only be performed in this state by a Louisiana licensed physician. This means that in such instances, nerve blocks (and similar procedures) are not delegable to a non-physician, such as a CRNA.

CONCERNS

Nerve blocks, however, are not without risk and can cause substantial harm to the patient if performed incorrectly. This is because the procedure involves inserting and guiding a sharp needle proximate to the nerve bundle and injecting powerful pain blocking drugs to temporarily stop the nerves from communicating pain to the brain. The risks associated with such a procedure are inherent due to the fragile nature of the body’s nervous system. This is even more true because the most common areas of the body for nerve blocks are at the base of the neck (cervical spine) and the lower back (lumbar spine). Further still, some patients are simply difficult to anesthetize, making procedures such as nerve blocks particularly challenging.

As such, a poorly performed nerve block can cause highly painful, intense, and often permanent injury. Due to these and other risks, many physicians disfavor and even shy away from performing nerve block injections and will instead rely on other pain management resources to optimize patient care. Further still, the LSBME does not support the practice of physicians prescribing and administering nerve block injections based on a single in-office visit. There must generally be evidence of some further evaluation or diagnostic testing of the patient’s complaints prior to receiving a nerve block injection. The Board also recommends that physicians try out less invasive therapies before resorting to a nerve block.

When it comes to performing nerve block injections, it is equally important that the treating physician obtain the patient’s complete medical history and workup prior to treatment, and that the patient be fully informed of all material risks associated with the treatment before giving consent.