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R E G I O N A L
A N E S T H E S I A
that Horner's syndrome from your interscalene block is common and
inconsequential, may think poorly of your block — even if it was a complete success in your eyes. Ensure the catheter can be placed without
delaying surgery. A dedicated block area is ideal. Also remember you
must document that the surgeon actually "requested" the catheter in
order to be paid for it. Establishing that he wanted the block can additionally prevent you from being thrown under the bus if complications
occur, and help you when requesting more equipment or support.
3. Use the right equipment
A quality ultrasound machine can significantly decrease CPNB
placement time and increase success. Your machine should afford
easy visualization of anatomy for placement of your most common
blocks. Make sure you can record ultrasound images of your blocks,
associated with patient data and filed in the patient chart or stored
electronically in case of a billing audit. Don't forget to choose appropriate probes. For example, a curvilinear probe is a wise investment
if you do a lot of blocks that require deeper needle insertion, such as
sciatics or infraclaviculars.
There are multiple needles designed to improve ultrasound visualization, so trial and choose wisely. Don't forget that the crux of CPNB is
the infusion. Pick an infusion device that works best for your practice
and patient population. Today's options vary in design, programmability,
ease of use and price. Once you choose an infusion device, you must
decide whether to fill them at your facility, or order them prefilled.
4. Choose your local anesthetic wisely
Choosing a local anesthetic involves both initial injection during placement and subsequent infusion via the catheter. The majority of anesthesiologists infuse 0.2% ropivacaine (Naropin) via the catheter at pre-deter6 0
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 | O C T O B E R 2013
