medial unicompartmental knee replacements, I place an adductor
canal block with long-acting bupivacaine liposome instead of regu-
lar bupivacaine or ropivacaine, and add an iPACK block, which is
an infiltration between the popliteal artery and capsule of the knee.
Placing two quick blocks under ultrasound instead of using spinal
results in fewer side effects and provides longer-lasting pain relief.
Another example: During a combined bilateral breast reduction and
abdominoplasty, I placed bilateral TAP blocks for the abdominoplasty
and bilateral PECS I and II blocks for the breast reduction, taking
care to calculate the total dose of local anesthetic given. I used a total
of 100 mcg of fentanyl during the procedure. The patient awoke with
no pain.
3. Enhanced recoveries
I believe the single greatest obstacle preventing facilities from adopt-
ing a robust nerve block program is a lack of knowledge about the
costs involved. Many facilities simply don't understand the significant
cost savings regional anesthesia provides in terms of improved patient
outcomes. With the precision of ultrasound-guided nerve blocks, you
can reduce or even eliminate patients' need for opioids during and
after surgery.
Decreased opioid usage reduces recovery times as well as associat-
ed side effects such as post-op nausea and vomiting. It also greatly
decreases the amount of time your staff spends in the PACU treating
patients' pain. There's also the intangible element of patient satisfac-
tion. Most patients now have an increased awareness of the dangers
of opioids, and want to avoid using them whenever possible.
Decreasing opioid use also speeds up patients' post-op ambulation
and discharge times, which allows facilities to save staffing overtime
dollars.
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