4 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • J U L Y 2 0 1 8
CNBs can be challenging, and
they aren't appropriate for
every procedure, but for those
we consider particularly high
risk for extreme pain or certain
other complications, they're
well-suited. For example:
• Chronic pain patients are
likely to already be taking the
medications you'd typically use
to treat their post-surgical
pain. The potential impact of
opioids is blunted before they even get to surgery. CNBs can buy
us time until we figure out how to provide pain control with tradi-
tional means. We don't have to rely on massive doses of opioids
to make them reasonably comfortable once 24 hours have
passed and the anesthetic provided by a single-shot local periph-
eral nerve block has worn off.
• Patients with worrisome comorbidities, such as pulmonary
disease, or who are very elderly, and who likely wouldn't tolerate
opioids well. You want to minimize their exposure to medications
that can exacerbate respiratory dysfunction or lead to other
problems.
• Patients who've had particularly painful procedures, such as
total knee and shoulder replacements. Ankle and midfoot proce-
dures also fall into this category. We're an orthopedic hospital,
PATIENT SELECTION
Who Are the Best
Candidates for CNBs?
• SWEET RELIEF
Nerve blocks can help
patients recover after
notoriously painful
shoulder replacements.
Gregory
Hickman,
MD
