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R E G I O N A L
A N E S T H E S I A
30ml to 40ml of bupivacaine or a bupi-
we rely on traditional nerve stimula-
vacaine-lidocaine mix for interscalene
tion, which is very effective in experi-
blocks before shoulder, arm and
enced hands.
elbow surgeries, and for supraclavicular blocks before elbow, forearm,
Setting expectations
wrist and hand surgeries. The drugs
We tell patients that by numbing the
have different effects of onset and
extremity near the surgical site, we're
duration. Bupivacaine has a longer life
able to decrease the amount of nar-
than lidocaine for extended post-op
cotics needed to control their pain,
pain management. For more involved
which helps limit PONV risk and post-
procedures, lidocaine's quicker onset
op discomfort, and decrease the
is the better option for limiting
amount of inhalational agents used dur-
patients' discomfort. Mixing the 2
ing surgery. Patients are told they'll ulti-
anesthetics results in fast-acting, long-
mately wake up quicker, their recover-
lasting blocks.
ies will go smoother and they can
expect 10 to 12 hours of virtually pain-
A typical block can be placed in
about 15 minutes and reach full effect
free convalescence at home with mini-
in about 20 minutes. However, placing
mal use of medications.
interscalene blocks in individuals with
Even the best-choreographed rou-
large, thick necks can prove difficult.
tines can backfire when blocks prove
The block might not be technically
difficult to place and surgeons, espe-
more difficult to perform, but finding
cially, may become antsy. But sur-
critical anatomical landmarks to
geons and patients ultimately expect
ensure targeted nerves are reached can
efficiency in the outpatient setting, so
be problematic. Careful pre-procedure
a regional program must consistently
evaluations will identify prime block
strive to deliver on-time case starts
candidates and, just as importantly, flag
and delay-free discharges. OSM
patients in whom blocks may prove difDr. Nadro (drb nadro@yahoo.com) is the
director of the anesthesiology department
and the co-medical director at Oak Brook
(Ill.) Medical Management.
ficult to place. Ultrasound guidance
certainly helps locate target nerves, but
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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
