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R E G I O N A L
A N E S T H E S I A
DRAWBACKS
Continuous Blocks Aren't for Everybody
C
ontinuous nerve blocks are not without their drawbacks.
• The cost of equipment. It's an advantage to do blocks using ultrasound,
but ultrasonographic equipment is a major purchase for a smaller surgery center. But as William F. Urmey, MD, associate attending anesthesiologist at
the Ambulatory Surgery Center at the Hospital for Special Surgery in New York,
N.Y., explains, "the advent of portable ultrasonographic guidance and catheters
lets you place the needle or catheter optimally to ensure analgesia of a specific
area."
• CPNBs take time to place. A single-shot block takes a minute, but placing a
catheter takes time, says Jeffrey M. Richman, MD, director of regional anesthesia
and acute pain at the University of Maryland St. Joseph's Medical Center in
Towson, Md.
• CPNBs require an additional time commitment. Not only do CPNBs take longer to
place, but they require a 24/7 pain service to follow up with patients, answer any
questions and address any issues.
• CPNBs are not recommended for every case. "Sometimes pain is an advantage
in understanding what is happening to the patient," says Dr. Urmey. "In these
cases you don't want a complete blockade; a partial blockade may be warranted."
Also, if there is a chance for compartment syndrome, a block is not recommended. Additionally, septic patients are not candidates for regional anesthesia. CPNBs
are not an option for patients with coagulopathy or abnormal bleeding, and in certain cases, with severe neuropathy.
• The patient must be able to care for himself. A CPNB should not be placed in a
person who is mentally incapacitated. Ensure a caregiver will be present to help
out with the care of the patient and the catheter. "If sending a patient home with a
catheter, ensure the caregiver is capable of helping out, including removing the
— Gail O. Guterl
catheter when instructed," says Dr. Richman.
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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 O N L I N E | O C T O B E R 2013
