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P A I N
C O N T R O L
IMPROVED OUTCOMES
Ortho & Regional — Perfect Together
JOINT EFFORT Single-injection blocks can provide up to 24 hours of pain relief after outpatient rotator cuff repair.
Perhaps more than any other specialty, orthopedic surgery lends itself to the practice of regional anesthesia," say Mayo Clinic researchers in the June 2010 issue of Anesthesiology Clinics (tinyurl.com/krxz546).
Here are their reasons.
• Upper extremity surgery. Interscalene blocks for shoulder surgery and axillary brachial plexus blocks or infraclavicular brachial plexus blocks for hand surgery lead to less pain, faster ambulation and faster discharges. Single-injection blocks can provide 12 to 24 hours of pain relief after shoulder procedures, but patients may experience significant discomfort when the blocks wear off. Continuous nerve blocks can extend that pain relief for several days, but catheter-based analgesia after shoulder surgery remains a controversial practice.
• Lower extremity surgery. Post-op pain may be a limiting factor in discharging hip arthroscopy patients from the outpatient setting, but post-op intra-articular injections lower
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ment, such as endotracheal intubation, thus increasing the safety of the procedures and reducing strain on anesthesia providers.
Cautious approach
Of course, regional anesthesia isn't for everyone, and placing blocks isn't free of potential complications. The failure rate can be as high as 50%, depending on the skill of the administrating provider. Starting a regional program therefore requires careful planning, including extensive education and training of your providers as well as your entire clinical team.
Regional is contraindicated if there is any skin lesion, infection or skin eruption at the site of the block. Be cautious with diabetics because some evi-
