Tourniquet Issues #2
STYLE POINTS for Intercostobrachial Nerve Block I have mentioned elsewhere the need to cover the tourniquet site for an optimum effect. One of those sites is the inner upper arm for a tourniquet used for elbow, wrist and hand cases. This single shot block is usually used in combination with a supraclavicular or infraclavicular.. read more →
Total Shoulder, Bad Lungs
NOT MY USUAL STRATEGY I’ve mentioned elsewhere on this site that I have successfully taken care of many patients with this particular scenario, even those who are ‘oxygen-dependent’. The basic dilemma is whether to offer an interscalene block to someone that may have respiratory embarrassment due to spread to the phrenic nerve, knowing that without.. read more →
Arteries through C5
Over and over again, I am reaffirmed of the of the ‘everyday advantages’ of utilizing ultrasound for peripheral nerve blocks. … REGISTER for FREE to become a SUBSCRIBER or LOGIN HERE to see the full article! read more →
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 →
CPNB for AKA
I have done continuous blocks in the past for post-operative analgesia (and to mitigate the risks of persistent pain and phantom pain and a multitude of other potential benefits) for amputations and as the primary anesthetic for foot amputations and BKA’s many times in the past. I have more consistently been performing CPNB’s.. 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 →
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 →