function. With elastomeric pumps, unresolved pain is often the first
indication that the local anesthetic isn't being delivered consistently.
• Precise placement. Most blocks are now placed with ultrasound
guidance, making placement easier and more precise. Anesthesia
providers can see exactly where nerve bundles are located, and place
catheters to deliver local anesthetic precisely around the bundles where
it will provide the most benefit.
Emerging catheter and needle systems make the placement of nerve
blocks even more exact. "Echogenic needles are more reflective than
traditional ones," says Dr. Margulis. "They show up clearer on ultra-
sound displays, making it easier to place the catheter in the correct
location."
Catheter-over-needle systems, which allow for a more efficient sin-
gle-step block placement, can also be used instead of the more tradi-
tional catheter-through technology, according to Ms. Winchester.
"Some doctors prefer them because they more closely mimic the ease
of placing single-shot blocks," she says. "Other physicians say catheter-
over-needle systems make it harder to get the catheter to stay where it's
placed."
• Dedicated rooms and block nurses. Placing blocks in procedure
rooms decreases patient time in the OR and improves a facility's
workflow, as the blocks can be performed while the operating room is
being turned over from the previous case.
Block rooms should be outfitted with the equipment and supplies
needed to place blocks, including monitoring equipment, a nerve stim-
ulator, needles, local anesthetics and infusion pumps.
Dedicated block nurses experienced with placing and managing
CNBs increases patient safety and the overall efficiency of the proce-
dure. They can set up the block placement space, keep supplies
organized during the procedure and monitor the patient's vital signs,
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