Sample Discharge Instructions for Peripheral Nerve Block Patients

ASC Durango (Colo.) recently underwent its first AAAHC survey and achieved accreditation. As a result of the survey, the ASC has identified areas to target for improvement. One such area was education of patients undergoing post-operative peripheral nerve blocks, says Cheryl Desko, RN, clinical director for the ASC.

"We have instituted a post-operative peripheral nerve block instruction sheet to allow patients that have received a PNB the knowledge of what to expect once they get home," she says.

Below is a sample version of ASC Durango's discharge instructions for peripheral nerve block patients you can adapt for use in your own surgery center.

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Discharge Instructions for Peripheral Nerve Block Patients

The following nerve block was performed for your surgery: _______________________

Your nerve block is expected to last between about _______ am/pm and _______ am/pm

This is an estimation as to how long your nerve block will last. Your nerve block may wear off earlier or may last longer.

Taking Your Pain Medication

If needed, your surgeon will give you a prescription for pain medication. Start taking this medication before the nerve block first begins to wear off or when you first begin to feel discomfort. The idea is to have pain medication in your body before the nerve block wears off. It takes about 60 minutes for the oral pain medication to become fully effective.

Keep in mind that nerve blocks often wear off in the middle of the night. If you are going to bed and the block has not started to wear off or you have not had any discomfort, consider setting an alarm to go off in 2-3 hours so you can assess your block. If you notice the block is wearing off or you are starting to have discomfort you can then take your medication.

You need to take your pain medication as prescribed. Pain medications can cause sedation and decrease your breathing if you take more than you need for the level of pain you are having.

Nausea is a common side effect of many pain medications. You may want to eat something before taking your pain medicine to help prevent nausea.

Questions:

Please call (555) 123-4567 Monday – Friday between the hours of 6:30 am and 5:00 pm with any questions or call your surgeon per his/her discharge instructions.

What to expect after a nerve block

Nerve blocks affect many types of nerves, including nerves that control movement, pain, and normal sensation.  Nerve blocks cause feelings such as:

1. numbness
2. tingling
3. heaviness
4. weakness or inability to move your arm or leg
5. a feeling that your arm or leg has “fallen asleep”.

A nerve block can last for 2-36 hours or more depending on the medications used.  Usually the weakness wears off first. The tingling and heaviness usually wear off next. Finally you may start to notice pain. Keep in mind that this may occur in any order. Once a nerve block starts to wear off it is usually completely gone within 60 minutes.

Certain nerve blocks may cause other symptoms. If you have had a shoulder block or a block near your collar bone, you may have symptoms such as:

1. mild shortness of breath
2. a hoarse voice
3. blurry vision
4. unequal pupils
5. drooping of your face on the same side as the nerve block

These are common side effects of this type of nerve block. These symptoms usually go away within 12 hours.

If you have severe or prolonged shortness of breath, please go to the nearest Emergency Room

If you continue to feel the effects of the nerve block for longer than 48 hours, please call (123) 456-7890.

Protection of a Numb Arm or Leg

After a nerve block, you cannot feel pain, pressure, or extremes in temperature in the effected limb.  Because your arm or leg is numb it is at risk for injury. For example, it is possible to burn your numb arm or leg on a hot stove without knowing it. Here are some helpful tips to protect your arm or leg while it is numb:

1. While you are awake change position of your arm or leg often. This helps to avoid putting too much pressure on the limb for long periods of time.
2. While sleeping, pad the limb with pillows to avoid rolling onto it while you sleep. If you have had a shoulder or arm block, it is a good idea to sleep in a recliner with pillows under your arm to avoid rolling onto your numb arm as you sleep.
3. If you have a cast or tight dressing, check the color of your fingers/toes every couple of hours.  Call your surgeon if any look discolored.
4. If you have had a shoulder, arm, or hand block, you may go home with a sling. The sling will help to keep your arm in a safe position. Wear the sling at all times until the nerve block completely wears off.
5. If you have had a leg block, you may have difficulty bearing weight on that leg. You may be sent home with crutches to use until the nerve block wears ff. Have someone assist you with walking until the nerve block completely wears off.
6. Use caution in cold weather. Your numb leg or arm will not be able to feel extremes in temperature. Be sure to cover your limb appropriately before going outside in order to prevent frostbite.
7. Ask your family or other support people to help you with the above tips.

Source: ASC Durango (Colo). Adapted and reprinted with permission.