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Regional Nerve Block
Regional Nerve Block is a precisely targeted anaesthetic technique that injects local anaesthetic around specific nerve bundles under ultrasound guidance - producing complete numbness and pain relief in the exact body region requiring surgery while the patient remains awake, comfortable, and free from systemic opioid side effects.
Overview
Regional Nerve Block uses real-time ultrasound imaging to guide a fine needle to the precise anatomical location of the target nerve or nerve plexus, where a volume of local anaesthetic is deposited around the nerve - blocking transmission of pain signals from the surgical area with exceptional accuracy. Modern ultrasound guidance has transformed regional anaesthesia - dramatically improving block success rates, reducing the required drug volumes, minimising vascular injury risk, and making blocks accessible to patients who were previously considered unsuitable. Peripheral nerve blocks can be used as the sole anaesthetic technique or combined with general anaesthesia to provide superior post-operative analgesia lasting 12 to 24 hours.
Types of Regional Nerve Blocks
The nerve block selected is determined by the anatomical region being operated on and the patient's specific needs.
- Brachial Plexus Block (interscalene, supraclavicular, infraclavicular, axillary - for upper limb surgery)
- Femoral Nerve Block and Adductor Canal Block (for knee surgery)
- Sciatic Nerve Block (for below-knee and foot surgery)
- Fascia Iliaca Block (for hip fracture analgesia)
- Transversus Abdominis Plane Block (TAP - for abdominal wall analgesia)
- Serratus Anterior and PECS Blocks (for breast and thoracic wall surgery)
- Continuous Nerve Block via Perineural Catheter (for extended 48-72 hour post-operative analgesia)
Risk Factors for Nerve Block Complications
Identifying patient and anatomical risk factors ensures the safest and most appropriate block selection.
- Coagulopathy - increases haematoma risk around deep nerve block sites
- Pre-existing peripheral neuropathy - may be worsened by nerve block
- Infection at the planned block site - absolute contraindication
- Severe respiratory disease - interscalene block causes ipsilateral phrenic nerve palsy in 100% of cases
- Obesity - makes ultrasound visualisation of deep nerves more challenging
- Patient unable to report paraesthesia or pain during injection - impairs safety monitoring
Indications for Regional Nerve Block
Regional nerve blocks are indicated when targeted anaesthesia and post-operative pain control of a specific body region are the primary goals.
- Upper limb surgery - shoulder, elbow, forearm, wrist, and hand operations
- Lower limb surgery - knee arthroplasty, ankle fracture fixation, foot surgery
- Hip fracture analgesia in the emergency department and peri-operatively
- Breast surgery analgesia and anaesthesia
- Abdominal wall surgery and laparoscopic procedure analgesia
- Chronic pain syndromes - diagnostic and therapeutic nerve blocks
- Paediatric anaesthesia as adjunct to reduce post-operative opioid requirements
- Cancer pain management requiring targeted regional analgesia
Key Benefits
Discover the advantages of choosing our regional nerve block services.
Targeted single-limb anaesthesia and analgesia avoiding systemic effects of general anaesthesia
Dramatic reduction in post-operative opioid requirements reducing nausea sedation and constipation
Superior pain control for 12 to 24 hours after major shoulder knee or foot surgery
Ultrasound guidance achieves above 95% success rate with excellent patient comfort
Perineural catheter provides multi-day analgesia supporting early physiotherapy
Clinical Features
The technology, techniques and clinical approach behind our regional nerve block.
Real-time ultrasound visualises needle tip and local anaesthetic spread throughout
Test dose before full injection prevents inadvertent intravascular injection
Ultrasound guidance significantly reduces minimum effective local anaesthetic volume
Doppler imaging identifies blood vessels before needle advancement
Perineural catheter extends block benefit to 48 to 72 hours post-operatively
Preparation Instructions
After a nerve block, the affected limb is numb and weak - protect it from burns, pressure, and injury until full sensation and strength return. Do not drive or operate machinery while the block is active. Report any persistent numbness, weakness, or tingling beyond 48 hours after the block should have worn off - this requires urgent neurological assessment. Keep follow-up appointments as scheduled and inform your anaesthesiologist if the block provides inadequate pain control.
The Procedure
Step-by-step guide to what you can expect during your regional nerve block procedure.
Ultrasound Setup and Target Identification
The anaesthesiologist applies ultrasound gel and uses a high-frequency probe to identify the precise anatomical location of the target nerve -- visualising it alongside vessels and fascial layers in real time.
Skin Preparation and Local Anaesthesia
The skin is cleaned with antiseptic. A small bleb of local anaesthetic numbs the needle insertion site -- ensuring only mild pressure is felt during the subsequent block needle placement.
Needle Advancement Under Ultrasound
The block needle is advanced toward the target nerve under continuous real-time ultrasound guidance -- the needle tip visible on screen at all times with trajectory adjusted based on live imaging.
Local Anaesthetic Injection and Spread Confirmation
A test dose confirms extravascular placement before the full volume is deposited around the nerve. The anaesthesiologist watches local anaesthetic spread circumferentially around the nerve on ultrasound.
Block Onset Assessment
The developing block is assessed at 5-minute intervals checking for progressive numbness warmth and heaviness. Full surgical anaesthesia develops within 15 to 30 minutes depending on the agent used.
Perineural Catheter for Extended Analgesia
When prolonged post-operative analgesia is needed a soft perineural catheter is placed alongside the nerve for continuous local anaesthetic infusion -- providing excellent pain control for 48 to 72 hours.
What to Expect
Real-time ultrasound imaging allows your anaesthesiologist to visualise the target nerve and watch the local anaesthetic spread around it in real time. The needle insertion causes only mild skin discomfort after local anaesthetic skin infiltration. You will feel the block developing as progressive warmth, heaviness, and numbness over 15 to 30 minutes. You remain awake and comfortable throughout surgery or the block provides excellent post-operative pain relief for 12 to 24 hours.
Frequently Asked Questions
Common questions about regional nerve block.
Related Services
Explore other services in our Anaesthesiology department.
General Anaesthesia
Spinal Anaesthesia
Epidural Anaesthesia
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