Intravenous Regional Anaesthetic Blocks

Intended Benefits

Intravenous regional anaesthesia, or IVRA, is a procedure used to treat painful limb conditions where the pain is thought to be caused by the over-activity of the sympathetic nerves.

These nerves normally control blood supply, skin colour, skin temperature, skin texture and sweating. In some pain syndromes these nerves become overactive leading to a condition called Complex Regional Pain Syndrome (CRPS), which is also sometimes referred to as Reflex Sympathetic Dystrophy (RSD).

People with a CRPS/RSD have differing symptoms but will usually be experiencing one or more of the following symptoms in the affected limb:

  • Severe burning pain
  • Pain and swelling which gets worse when they use the limb
  • Extreme skin sensitivity
  • Weakness and muscle wasting
  • Limb becoming hot or cold independently of the rest of the body
  • Sweating
  • Colour changes
  • Altered hair and nail growth
  • Altered skin texture -for example shiny skin

Often a course of IVRAs will be performed, in the hope of reducing pain and swelling in the affected limb.

Risks of this treatment

You may find that the cuff (tourniquet) feels rather tight and uncomfortable and that you get ʻpins and needlesʼ. You may get a headache and/or a ʻstuffyʼ nose. You may also experience a warm feeling ʻdown belowʼ (across your perineum).

There is a small chance that the drug may cause your blood pressure to drop and you to become dizzy or faint, which is why we closely monitor your blood pressure during and after the procedure. Some people feel light headed if they stand up quickly after the procedure and this can last a few days.

As with any injection, there is a very slight chance of getting an infection where the needle is placed. Every effort is made to avoid this with use of skin-cleaning solution, sterile gloves and equipment. The procedure is made as safe as possible by being performed by an experienced pain doctor who constantly monitors you throughout the procedure. You may discuss the risks further with your pain doctor.

Pre-operative assessment & Care

If you become pregnant, have any major illnesses/hospital admissions or start taking anticoagulant drugs (for example warfarin or clopidogrel) discuss this with the pain doctor before the procedure. If you have diabetes, you may need to make some changes to your diabetes medicine or diet on the day of the procedure. You should discuss this with your pain doctor before your procedure.

  • Take all your usual medication including your painkillers
  • Bring all your usual medication, or a list of what you are taking with you.
  • Make sure that someone will collect you, take you home, and is available to stay with you overnight.

During the procedure

At the Day Surgical Unit your pain doctor will see you. He or she will assess your pain again, and explain the procedure fully. A small cannula or tube will be put into a vein in the painful limb (the drug will be injected through this) and another in a vein in another part of your body (this extra cannula is a safety precaution).

A cuff (tourniquet) is then wrapped around the painful limb. The cuff is placed away from the most painful part and then in- flated with air to make it tight enough to prevent the drug travelling in the blood out of the limb into the rest of the bodyʼs circulation.

Once the cuff is tight the drug is injected. The cuff is left tight for about 10 minutes, and then partially deflated for a further 5 minutes, then deflated. The procedure takes about 30 minutes. After the procedure, the nurses in recovery and on the ward will check your blood pressure, pulse and respiration rate frequently

After the procedure – what to expect

For some people, the IVRA may not reduce their pain at all or may make it feel worse. You may feel weak or tired for a little while after the injection so we advise that you rest for 24 hours.

During this time you should not: drive a car or operate equipment, sign any legal documents or drink alcohol. You should continue taking your usual medication and the next day you may take a bath or shower and remove any plasters. Please contact your GP (family doctor) if you have any symptoms causing you concern and if:

  • There is unusual redness or swelling at the injection site
  • Your temperature is 38° C (100.4 F) or greater

After discharge home To get the best out of your IVRA you should:

  • Continue with your usual medication including your painkillers
  • Generally keep active, but within your pain limits
  • Re-introduce previously painful activities gradually over the next few weeks
  • Maintain any exercise routine you may have been given by your physiotherapist

You will either be given a follow-up appointment to attend the Pain Clinic after your procedure, or be followed up by telephone. Whenever you come to the Pain Clinic, please bring all your usual medication or a list of what you are taking with you.

After the procedure – what to expect

For some people, the IVRA may not reduce their pain at all or may make it feel worse. You may feel weak or tired for a little while after the injection so we advise that you rest for 24 hours.

During this time you should not: drive a car or operate equipment, sign any legal documents or drink alcohol. You should continue taking your usual medication and the next day you may take a bath or shower and remove any plasters. Please contact your GP (family doctor) if you have any symptoms causing you concern and if:

  • There is unusual redness or swelling at the injection site
  • Your temperature is 38° C (100.4 F) or greater

After discharge home To get the best out of your IVRA you should:

  • Continue with your usual medication including your painkillers
  • Generally keep active, but within your pain limits
  • Re-introduce previously painful activities gradually over the next few weeks
  • Maintain any exercise routine you may have been given by your physiotherapist

You will either be given a follow-up appointment to attend the Pain Clinic after your procedure, or be followed up by telephone. Whenever you come to the Pain Clinic, please bring all your usual medication or a list of what you are taking with you.

CONTACT US

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Telephone: 01256 377741
Email: info@thepainteam.com

Fax: 01256 377665 Address: The Pain Team c/o The Hampshire Clinic Old Basing Hampshire RG24 7AL

Practice Manager: Karen: karen@thepainteam.com Admin: Michelle: michelle@thepainteam.com Rob Baylis private secretary & medical legal work Name: Philippa Williams Email: pippa@thepainteam.com Tel / Fax: 023 9225 6300 The Pain Team Limited Registered Company Number: 07204359 Registered in England and Wales