I've had good ones and bad ones too, There is nothing like having a needle pierce a major nerve, It can definitely light you up like a christmas tree. The actual procedure may varry from doc to doc or where you have it done. I've had them done in the hospital by anesthesiologists with a little versed and I've had them while sedated with remifentanil and propofol, The remi fent is a powerful and very short acting pain killer, 3-10 minutes and proponol or profonol can also be used for very short procedures that require the patient to be imobile, no twitching or jerking when you hit the nerve. Using a sedative that causes amnesia also makes returning for another a much easier decision.

The idea of nerve blocks isn't partricularly to provide lasting relief, once the numbing agent wears off your back to square one , hopefully withoutt too much trauma to the nerve. The more trauma to the nerve the more post procedural pain when the anesthestic wears off. The more frequntly it's done the more likely you will have scarring issues with that nerve.

If a nerve block is succesful, they will likely discuss some type of nerve destruction procedure, radio frequency or chemical ablation. These types of nerve ablation or destruction are also temporary but last months rather than days, nerves regenerate in 3-6 months but 6 months of relief from nerve pain is a huge relief. Unfortunately these procedures have to be repeated several times a year if it's the only way to maintain relief.

It is invasive, the more time they stick a needle into a nerve the more scar tissue that builds up which can either amplify the pain signal when the nerve regenerates or can minimize the pain signal from the scarring caused by needle insertion.

Confidence in your doc, the use of flouroscopy to guide the injection are a must. As far as sedation, It depends on the faclility that it's done at. Surprisingly, I got the best sedation at my PM clinic. They do all their procedures on site, have the rescue equipment if something happens and the doc is more comfortable workng in his own procedure room, set up the way they want.

If it's done at a hospital, it's likely done in a radiology room where they don't have the means to provide anesthesia and a crash cart or in a vascular radiology room which are rarely equiped the way a surgery suite is with rescue abilty. It's always been an anesthesiologist performing these blocks, but if the anesthesiologist is your PM doc, things should go better than your PM doc sending you off to the hopital to meet a strange anesthesiologist for the first time that knows nothing about your history.

Maybe it's just a comfort thing knowing my PM doc isn't going to let me suffer if I'm in pain rather than being run through the radiology dept and using the hospital staff anesthesiology group. You may have 3 done in one year and end up with a different anesthesiogist each time at a hopital. Someone that knows nothing more about you other than which nerve your PM doc wants blocked.

Surprisingly I feel safer at the clinic with a crash cart next to me and narcan and rescue meds on the procedure table. I know there not going to use a surgical suite that's equiped the way the clinics procedure room is. Obviously the clinic I go to has gone to great expense to build and set up their own procedure room and recovery room and handle things themself rather than farming out procedures to a doc you never met and you will never meet again.

The use of anesthesia or sedation is really up to the doc and the facility you have it done at. The ones at the hospital were always done in a basic Xray or vascular study suites where sedation at best was a couple mgs of Versed. It's a pretty basic procedure, But your care is determined by the doc and the facility it's done at.

The only real difference is the comfort level during the actual procedure, Like others have said, after a few seconds they do numb the nerve they have pierced, but those few seconds are not pleaseant if you are awake. I would certainly talk to your doc and ask him about sedation, where it's done and about nerve ablation if the block is succesful. What method he uses for ablation when blocks are succesful and provide a lot of relief.

Just like surgical methods and anesthesia options, there are alot of variables in nerve blocks, who, where, sedation or not and what kind and follow up care, etc.
Good luck, Dave
PS. Before you self medicate prior to a procedure, find out what they are goning to use or provide. If you have a load of opiates on board out of fear and allow them to give you anesthesia without their knowledge, your putting yourself at great risk.