them. Nowadays, residents are being trained in ultrasound, but the older
generation of providers needs to catch up. Moreover, to confidently and
consistently place CNBs, providers need to learn not only how to use
ultrasound, they also have to learn how to use it in a more advanced way.
They have to assess not only where the needle goes, but also whether the
catheter is in the right spot to deliver the anesthetic where it can provide
the most benefit.
We have to find ways to ensure more providers learn how to place
ultrasound-guided blocks and apply the practice to a larger patient
population. Those efforts can begin with your willingness to support
your providers in their efforts to learn block placement techniques.
• Plan for complications. As with every procedure, you have to
think about complications, such as the potential for infection and
catheter dislodgement. Prolonged exposure to local anesthetic may
cause nerve toxicity. Also, catheters can break, leaving your patient
with a foreign body in the tissue. These things don't happen frequent-
ly, of course, but you have to consider them.
We're now using catheters in inpatients having knee replacement sur-
gery, after administering adductor canal blocks. That's an example of the
learning curve that accompanies CNBs. Adductor canal blocks don't
J U L Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 4 3
but patients who've had other types of procedures — those in the
abdominal area, for example — may also benefit from continu-
ously soaking the surgical area with local anesthetic.
• Patients with sleep apnea are a particular concern in ambu-
latory surgery settings. Knowing, as we do, that about 20% of
orthopedic patients have sleep apnea, and most are undiag-
nosed, you have to worry about sending someone home with opi-
oids when that person may already have a problem that affects
respiratory status. — Stavros G. Memtsoudis, MD, PhD
