Block Evaluation 2
DON’T MUDDY THE WATER So, here you are in the PACU with a patient that just had a big surgery. The nurse called you here because the patient is hurting (“and I’m not sure your block is working, Doctor”). The patient is ‘mostly’ alert and says that they are hurting “over there”, pointing vaguely.. read more →
Use a Longer Needle
I discussed in a previous Tip of the Week about some of the advantages of using a larger gauge needle, and today I would like to discuss advantages of using a longer needle to improve your success. I encounter commonly the view, not put into words exactly, but expressed in behavior and choice, that.. read more →
Leaking Catheters
LEAKING IS NOT NORMAL OR REASONABLE I have talked with many people who do blocks -and some who do LOTS of blocks that are not bothered by leaking peripheral nerve catheters. “They just leak” is what they say like it doesn’t matter really and it can’t be helped anyway. Some (forgive my directness) don’t.. read more →
Exit Strategy
As I talk with ‘happily surprised’ patients post-operatively on rounds or on telephone calls, sometimes they transition to what appears to be fear and dread. It is when they go from how they feel now to what they will feel later when the peripheral nerve block catheter is pulled. Many patients go home with.. read more →
Infrastructure
THE CART AND THE HORSE Improving your nerve block program will come in the form of learning or improving technical skills or from organization of your infrastructure. I commonly emphasize in my lectures about the habit that most people have of focusing primarily or exclusively on learning technical skills in order to build their.. read more →
The ‘Right’ Way
WELL, THAT’S NEW TO ME… I have come in contact at more than one practice lately with an application for a block that I would not have thought reasonable before now. It is the use of a popliteal sciatic nerve block (as a single injection) for posterior knee pain for total knee arthroplasty. I.. read more →
Rescue Blocks
NERVE BLOCK TO THE ‘RESCUE’ You’ve prepared for a new block, you have an agreeable surgeon, and you have a great application for it with the very reasonably-sized patient in front of you in the holding area….but you’re not sure that the first (or one of your first) attempt will be ‘quick and slick’... read more →
Get A Grip
One of the most common errors I see people commit as they begin using ultrasound is … REGISTER for FREE to become a SUBSCRIBER or LOGIN HERE to see the full article! read more →
Use a Bigger Needle
BIGGER NEEDLES Many people lean toward smaller needles for single injection nerve blocks. I will usually use 21 or 22 gauge needles for an ultrasound-guided block if it is a single injection block that is superficial. There are advantages to using a heavier 17 to 19 gauge needles in other circumstances though. … .. read more →