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R E G I O N A L
A N E S T H E S I A
Remember not to overfeed catheters, especially if you can't visualize
and are not stimulating them. It makes no sense to perfectly position
a needle next to a nerve (either by nerve stimulation or ultrasound)
and then blindly thread your catheter 3 to 5cm beyond it.
CPNB PLACEMENT
Making the Case for Continuous Nerve Blocks
ith a continuous nerve block, you can send a patient home and know
he won't have pain for 2-3 days, getting him past the worst period for
post-operative pain. "Regional anesthesia is the only way you can
guarantee ongoing analgesia without the side effects of general anesthesia,"
says William F. Urmey, MD, associate attending anesthesiologist at the
Ambulatory Surgery Center at the Hospital for Special Surgery in New York, N.Y.
Other benefits include:
1. Patient satisfaction. Patient satisfaction is high for continuous blocks, 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. Patients
experience fewer side effects such as nausea and vomiting, sedation, constipation and pruritis, he says. Continuous nerve blocks are associated with minimal
side effects and provide unlimited block duration at a distance from spinal and
epidural areas so you don't have problems with the neuraxis, says Dr. Urmey. "If
patients are taking anticoagulants, CPNBs let you avoid epidural hematomas.
They have better sleep patterns post-operatively, less urinary retention and are
up and about quicker and able to commence therapy."
In his research, Dr. Richman has determined there is a 35 to 50% reduction in
pain scores for patients with a CPNB as compared with those taking opioids.
CPNB patients often receive a call from the anesthesiologist to check on their
progress. "Anecdotally, I have seen this type of attention and care increase our
reputation as a good place to go for surgery," 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
