Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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OSE_1309_part3_Layout 1 9/6/13 12:21 PM Page 132 ANESTHESIA ALERT case selection, combined with clear and thorough communication. If you understand and mitigate the risk factors, you can achieve the benefits while minimizing the potential dangers. • Upper extremity CPNB. This achieves and maintains potent analgesia and is widely used in the outpatient setting. It has several indications. For years, brachial plexus catheters have enabled patients having surgery on the shoulder, arm, forearm, wrist or hand to report lower pain scores and less nausea, and be discharged faster. Thanks to interscalene catheters, many shoulder surgeries that might previously have required hospital admissions have also been done as outpatient procedures. The same can be said of supra- and infraclavicular catheters, which have increased the number of hand and arm procedures carried out in outpatient settings. The primary concern with upper extremity CPNB is respiratory complications. Supra- and infraclavicular blockades can cause pneumothoraces — air between the lung and chest — that aren't always immediately apparent. The risk of this complication may be increased when using a larger needle and with the increased manipulation necessary for catheter placement. Phrenic nerve blockade is another real and potentially very significant risk of interscalene and even supraclavicular blockade. One of the best ways to minimize these risks is to use ultrasound, which not only gives real-time needle visualization and allows for more exact placement, it also lowers local anesthetic volumes, decreases insertion time and decreases discomfort. With or without ultrasound, be especially careful with continuous upper extremity blockade in patients with compromised cardiorespiratory function. • Lower extremity CPNB. Lower extremity CPNB is also increasing in popularity as anesthesia providers become more proficient with place1 3 2 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 | S E P T E M B E R 2013