Local Anesthetics

Local anesthetics block nerve transmission, which can reduce or eliminate pain for a short period of time. When the pain is relieved with a local anesthetic injection, information is obtained that can help to determine the cause of the pain. The actual structure, such as a joint, ligament or tendon, causing the pain can be blocked, or nerves that innervate the structure can be blocked a distance away from the pain generator. Different anesthetics are used depending on the desired duration of effect, such as Lidocaine, which has a duration of 30-60 minutes, or Bupivacaine, which can last 3-4 hours.

Many spine and sports conditions can be better understood by selective injections. A successful nerve block may help specifically when there is a probability of nerve injury from a disk hernitation, for instance. As another example, a hip joint injection may help to define whether the hip joint itself is causing pain; conversely, if the block does not successfully affect the pain pattern, the injection result may lead to a different determination of the source of the pain. Many common pain complaints have a variety of possible pain sources; therefore, precise injection techniques using a logical methodology and expert technique with sophisticated guidance equipment to rule-in or rule-out pain generators can efficiently lead an experienced physician to the source of the pain. Multiple blocks may be needed to finalize the pain generator.

Our experience has shown that most failed orthopedic surgical procedures are the result of a poor understanding of the original cause of the patient's complaints. Many surgeries are recommended solely on the basis of an X-Ray, MRI or CT scan, without a good functional examination and without test injections to try to prove the cause of the pain before the surgery. Almost every pain pattern that occurs in a patient's history has mutiple potential causes; both the surgeon and the non-surgeon have an obligation to make certain that the presumed cause of the pain is the true cause of the pain, as far as is practical, before offering an invasive, expensive, and irreversible surgical procedure.