Tuesday, January 05, 2010

The Miracle of the Nerve Block Pain Ball

Yes, that's what the doctors and nurses call it. I had the option to take just general anesthesia alone or to take the general along with a local nerve block anesthesia. I took both. It has been nothing short of miraculous.

I first need to mention that I have already had knee surgery some many years ago and still remember the experience. What I remember most from that experience of going under the knife was that I found myself groggily awaking from the general anesthesia then by chanting (more like moaning) over and over: "It huuuuuurts. It huuuuuuurts." I also vaguely remember being rolled over on my side in the recovery room and getting a shot of some opiate pain medication to shut me up.

This time, I just woke up with a slight headache from the anesthesia feeling otherwise pretty darn good and I said: "I'm alive! I made it! What time is it?" (new surgery as a middle-aged man with kids and a keen sense of mortality, new anxieties, but I digress ...) It happened to be just a mere three hours since they put me under and I felt ZERO pain. ZERO, ZIP, NADA. I was incredulous. How could that be?

Well, it was the local nerve block anesthesia that I had consented to in addition to the general anesthesia (which still got me sick while being rolled out of the hospital). What's even better about the local nerve block, which I'll describe a bit more in a minute, is that they let me take it home, in a manner of speaking. In other words, I'm still feeling ZERO pain, even more than 15 hours after the surgery took place.

Here's how the nerve block works: the anesthesiologists insert a tiny catheter into the leg (the catheter is no larger than fishing twine) and set it up right next to the femoral nerves (there's apparently a cluster of nerves in the groin area controlling certain areas of leg sensation. It's pretty cool how they locate this spot. They first use some kind of ultrasound to actually locate the nerve, then they insert the catheter and set it up next to the nerves. Then, to test whether they're close enough to the right nerves (such that the numbing medicine will work on the right part of the leg) and yet avoid penetrating the nerve, they stick a tiny electrode through the catheter and send a small pulse of electricity which stimulates the nerve causing certain leg muscles to twitch. When they get the right muscles twitching, they know they're in the right spot. Then they pull the electrode out and hook the catheter up to the numbing medicine. Now here's the great part. They give me a big dose to really numb up the leg right before surgery; but then they fill up the nerve block pain ball with enough medicine to maintain the nerve numbing for up to three days. And I get to take the ball home with me and even can adjust the distribution dosage of the medicine depending on my pain tolerance threshhold ability when the original high dosage begins to wear off. After the medicine is gone, I myself can just pull out the catheter (which they assure me is painless) and toss the used ball in the trash. For this reason, I have felt no pain all day. Now, I should mention that some people also get a second pain ball which controls the hamstring and calf muscles through the psiatic nerve. The process for this is the same as for the femoral nerve. But I didn't get this because the Doc probably thought I wouldn't need it given the type of surgery I was undergoing. However, they did locate this nerve cluster in my leg and give me a single dosage just before surgery, though they didn't insert the take home pain ball for it. So, the result is that I can still contract my hamstring muscle a bit and have some feeling on the underside of my leg.

The concept, though it was never explained to me this way, is like going to the dentist to get a crown, a filling, or a root canal. Anything that might require the jaw nerves to be numb. In such a case, the dentist usually injects a small amount of nerve-deadening medicine in the right part of the jaw and certain parts of the mouth, face, and jaw get all numbed up for a few hours. Then it wears off. With the leg, though, the dosage is higher and lasts longer. But the best thing for me is that, unlike the opiate pain meds, it doesn't affect the rest of my body and keeps me from feeling nauseated. That's what I usually suffer from the most and I am so glad that my nausea has been very short-lived while the general anesthetic was wearing off. My hope is that as the nerve block wears off, the pain will be tolerable enough so that I can avoid taking too much of the other pain meds.

All this said, there are still some drawbacks to the technology, though I think as of now that the benefits outweigh these drawbacks. Nonetheless, I know I have to be conscious of them. First, the nerve block deadens sensation in the entire leg, which means that not only do I feel no pain, but I also feel no leg. Thus I know that when I get up on my crutches to walk around, I have to be particularly careful in terms of knowing where my leg is at all times. And even though the leg is in a pretty sturdy stabilizer, I still have found my foot being dragged on the floor and had no sensation of it. So, essentially, if I'm not careful, I can stub my toe, twist my ankle, or worse and not ever feel it or know it until the nerve block wears off. Second, I know all too well that pain serves an important purpose. It transmits rules, so to speak, about how to naturally respond to the injury. It tells us when we need to rest an injured body part, it tells us when we need to seek the care of a physician for an injured body part, it tells us how the healing process is progressing and if something seems wrong with the healing process, etc. I have none of those. (For example, one practical concern along these lines that I currently have: I have no clue if my knee immobilizer is strapped too tightly and cutting off circulation to my foot and lower leg. Thus I have to constantly watch my toes to make sure they aren't turning blue.) Third, I have instructions to ice my knee for 24 hours. And I have had an ice pack on my knee since I got home early this afternoon. But I have no clue if the cold of the ice is really reaching down through all the bandages and clothing to affect the swelling like it should. I just have the ice pack taped on to the knee and hope it's working like it's supposed to. Fourth, and this is perhaps the most important drawback, is that I know in my mind that the pain will come. However, I have become accustomed to feeling no pain and so I might be lulled into a false sense of hope about what life will be like after the block wears off. The resulting pain could be unbearable (for which I do have a pain medication prescription), or it could be tolerable. Regardless, though, it's there and I'll feel it. And I can see how someone might be very upset with the doctors when that pain arrives. I can imagine the following questions coming from a patient like me: How can they keep me so pain free when the pain should have been at its worst and yet let me suffer with the residual pain? Why didn't they tell me how painful it would actually be? Why can't I get more of the nerve block? Etc.

In any event, as long as I keep the pain reality of my surgery front and center and try to be realistic about it, I think the nerve block pain ball is well worth getting.

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