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J O I N T
R E P L A C E M E N T
include:
• Interscalene block. For a total shoulder replacement in a patient
with no comorbidities.
• Supraclavicular block. To spare the phrenic nerve in a patient who
has asthma or COPD.
• Major conduction block. For a total hip replacement.
By far, the most complex cases from an anesthesia standpoint are
total knee arthroplasties, which generally involve a triple block. "The
triple block includes a single-shot sciatic block combined with a
femoral block and placement of a femoral catheter, followed by a lowdose, short-acting spinal anesthetic for the procedure itself," says Mr.
Berk-heimer. "I can't stress enough the importance of ultrasound technology, which enables me to visualize the needle stick and place these
blocks and catheters with pinpoint accuracy. Without this technology,
these procedures would be much more difficult, much more challenging, and significantly less safe and successful. And without the appropriate regional anesthesia techniques, there's no way these procedures
could be done in an outpatient arena."
Patients leave the surgery center with blocks that last up to 24 hours
and an elastomeric pain pump that will continuously administer anesthetic (ropivacaine is preferred because of its cardiotoxicity profile)
through the femoral catheter for another 48 hours. Patients also maintain an intravenous line so nurses can administer antibiotics or other
drugs at the patients' homes, if necessary. "Watching patients leave
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O U T PAT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M A R C H 2013
