Tourniquet Issues
Many times, a quality nerve block could be considered a ‘failure’ or the anesthetic plan has to be altered because the use of or the exact position of the tourniquet was not considered. You KNEW the case warranted a nerve block or a continuous nerve block, and you knew the appropriate nerves to block.. read more →
Back on their Feet Again
Tip of the Iceberg I have indicated on this website multiple times and in multiple ways that the superior post-operative analgesia provided by continuous nerve blocks has significant benefits. Patients can leave the hospital faster and more comfortable and with fewer side-effects from opioids. I would like to point out that they have.. read more →
Block Evaluation 3
WELCOME BACK! I have made a number of observations and recognized a number of patterns over the last several years working with nerve block patients. Here’s another I’d like to share. A point that I’ve made a dozen times in lecturing is that as you change or add techniques or processes, do so.. read more →
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 →
PACU Bypass
I have recently been inspired by one of my fantastic CRNA’s, Ashley Hayes, to begin bypassing the PACU, and it is kind of addicting, I have to say. I’ll go on record as saying that I know I broke one of my own rules of building up and preparing infrastructure in doing this, but.. 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 →
Block Evaluation
TAKE TIME TO LOOK BEFORE YOU LEAP Beyond visualizing a successful block on ultrasound, I usually will want to see an immediate effect of my local by asking the patient to raise their arm toward the ceiling (deltoids, C5 for an ISB) or extend their knee (for a femoral block). There are reasons why.. read more →
Safety
ANOTHER ARROW IN THE QUIVER I was happy to receive a round of texts this morning from a good friend of mine about a case that he had just performed. My friend, Dr Chip Criswell, has become quite proficient at performing ultrasound-guided nerve blocks, and I could brag about him and about other cases.. 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 →