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R E G I O N A L
A N E S T H E S I A
service before shoulder arthroscopies
nervous time and provides an amnes-
and hand procedures. We don't have a
tic effect before they're taken to the
dedicated pre-op block placement
OR. Fentanyl, which is rarely given, is
area — the PACU serves that purpose.
reserved for patients who are overly
The lone exception: Blocks before the
anxious or in pain.
The anesthesia provider and PACU
day's first case are placed in the OR as
the surgical team puts the finishing
nurses perform a pre-block timeout,
touches on the room setup.
mark the intended site and place the
block. Once the block is in, the nurses
Placing blocks without delaying the
surgical schedule can be a challenge.
continue to monitor patients until
We ask all patients to arrive an hour to
they're brought to the OR.
During back-to-back cases, we try to
an hour-and-a-half before their scheduled surgeries, more than enough of a
have an additional anesthesiologist
cushion to get them registered and
available to start the second block as
prepped for blocks.
the previous case is drawing to a
close. It's not always financially feasi-
The block consent that patients sign
outlines regional's risks and benefits,
ble to have an extra anesthesiologist
and the type of block to be performed.
available just to place blocks, so
The anesthesiologist then preps the
providers will typically help out if
patient, aided by PACU nurses, while
they're free between cases. Most
appropriate monitoring and supple-
often, anesthesiologists will place
mental oxygen is administered.
their own blocks as the operating
Patients are usually given mild seda-
room is being turned over. We haven't
tion — midazolam is used and titrated
found this to be a time-waster as long
to effect — so patients are less nerv-
as patients are registered early enough
ous and can better tolerate delivery of
and there's adequate staff available to
the local anesthetic. Patients can get a
assist.
block done without sedation as long
as they know what to expect, but
Careful selection
sedation takes the edge off during a
Many of our anesthesiologists use
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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 | J U LY 2013
