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4 4 O U T P AT 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 | A P R I L 2 0 1 4 of the device. Stimulation techniques in conjunction with ultrasound guidance have proven to be very helpful with difficult blocks. Dual guidance is particularly helpful in the early training phases of ultra- sound guidance. Stimulation is used as a positive reinforcement dur- ing ultrasound training. Specialized Toughy needles of multiple length and gauge are also used for the placement of continuous peripheral nerve block catheters. Toughy needles, often 17 gauge and 18 gauge, let the catheter pass through the needles. Recent introduction of catheter-over-the-needle devices allow for more efficient catheter placement and less leaking at the puncture site. • Nerve stimulator. There's still a role for nerve stimulation. At times it's the default choice, such as when ultrasound visualization is difficult or impossible. Most newer models address resistance regard- ing output. The ability to adjust frequency, milliamps and pulse width are standard features. • Continuous catheter trays. Customized nerve block and catheter trays contain all of the sterile supplies you'll need to place the block or peripheral catheter. Items such as sterile clear drapes, Chloraprep, Toughy needles, catheters, adhesives, syringes, local anes- R E G I O N A L A N E S T H E S I A PRECISION PLACEMENT Ultrasound lets you place blocks by looking at the screen, not the patient's skin. Pamela Bevelhymer, RN, BSN SIMPLICITY DOESN'T REPLACE EFFICACY The truth about EXPAREL ® (bupivacaine liposome injectable suspension) EXPAREL ® is promoted as providing pain control that lasts for up to 72 hours without the need for catheters and pumps. 1 Sound too good to be true? It is. In fact, based on further analysis of the data 4 , after 12 hours there was minimal to no difference between EXPAREL ® and placebo (normal saline) treatments on mean pain intensity as demonstrated in their two pivotal studies. 2-3 A K I M B E R L Y - C L A R K H E A L T H C A R E C O M P A N Y EXPAREL's studies only demonstrate 12 hours of pain relief. 2-4 Every day without costs you more 4 ON-Q*: Effective post-op pain management. For over 3.5 million patients and counting. Controllable. Long-lasting. Proven. 4 Contact your ON-Q* representative, or call 1-800-448-3569 for more information. OSE_1404_part2_Layout 1 4/4/14 2:38 PM Page 44