Nerve Blocks for Post-Surgical Pain Management: A Narrative Review of Current Research

Abstract

Opioids remain the mainstay of post-surgical pain management; however, concerns regarding addiction and side effects necessitate the exploration of alternatives. This narrative review highlights the potential of nerve blocks as a safe and effective strategy for post-surgical pain control. This review explores the use of various nerve block techniques tailored to specific surgical procedures. These include nerve blocks for abdominal surgeries; fascial plane blocks for chest surgeries; nerve blocks for arm surgeries; and nerve blocks for lower limb surgery including; femoral, hip, and knee surgeries. By targeting specific nerves, these blocks can provide targeted pain relief without the negative side effects associated with opioids. Emerging evidence suggests that nerve blocks can be as effective as opioids in managing pain, while potentially offering additional benefits such as faster recovery, improved patient satisfaction, and reduced reliance on opioids. However, the effectiveness of nerve blocks varies depending on type of surgery, and in individual patients. Rebound pain, which temporary increase in pain after a block wears off, can occur. In addition, some techniques require specialized guidance for accurate placement. In conclusion, nerve blocks show great promise as effective alternatives for managing post-surgical pain. They can reduce the need for opioids and their side effects, leading to better patient outcomes and satisfaction. Future studies should assess the long-term impacts of specific nerve blocks on mortality rates, cost-effectiveness, and their incorporation into multimodal pain management approaches to further enhance post-surgical care.

Keywords: complications; nerve blocks; opioid-sparing; pain management; postoperative pain; surgical procedures.

Figure 1

The transition from acute pain to chronic pain. This figure illustrates the complex process through which acute postoperative pain can progress to chronic pain: Surgical trauma or tissue injury activate nociceptive systems. Perioperative factors, such as the type of surgery, analgesic approach, and pain catastrophizing, interact with social-environmental and biological factors to influence pain modulation mechanisms. Increased postsurgical pain intensity and duration, driven by neurotransmitter activity, molecular mechanisms, stress responses, and MiR-339-5p activity, contribute to the development of high clinical pain intensity and chronic postsurgical pain.

Figure 2

Mechanism of local anesthetics. This figure illustrates how local anesthetics block pain signals: Normally, no pain signals are transmitted, but injury or inflammation triggers nerve pain. When local anesthetic is injected near the targeted nerves, it disrupts action potentials by blocking sodium (Na+) channels. The anesthetic penetrates in its non-ionic form, converts to an ionic form, and binds to sodium channels, ultimately blocking the transmission of pain signals and providing pain relief.