them with IPACK (interspace between the popliteal artery and the
capsule of the posterior knee) blocks," explains Dr. Memtsoudis.
"That's another sensory block, and it's replaced the schiatic nerve
block."
3. A fast-acting block
One of the challenges of anesthesia is getting patients back on their
feet as quickly as possible. Help appears to be on the way in the
form of a new spinal anesthetic called Clorotekal (chloroprocaine
hydrochloride), which wears off in about 40 minutes. Clorotekal,
which also has a quicker onset time and is associated with a lower
urinary retention rate than other anesthetics, was unveiled this past
spring at the American Society of Regional Anesthesia (ASRA) and
Acute Pain Medicine's 43rd annual conference. In one study,
patients given Clorotekal were reportedly ready to be discharged
150 minutes after being injected, beating bupivacaine study patients
out the door by some 80 minutes.
4. Wide-awake hand surgery
Anesthesiologists can agree that less sedation is safer than more seda-
tion, and that the safest sedation is no sedation, says Donald Lalonde,
MD, the chief of plastic and reconstructive surgery at Dalhousie
University in Saint John, New Brunswick, Canada. That philosophy
inspired Dr. Lalonde to develop what he calls WALANT — "wide
awake, local anesthesia, no tourniquet" — hand surgery.
The technique, which is used for wrist and hand procedures, uses
lidocaine or epinephrine injected only at the areas of dissection.
Among the advantages, says Dr. Lalonde, is patients can move their
fingers on command while the surgery takes place.
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