A U G U S T 2 0 1 5 O U T P A T I E N TS U R G E R Y. N E T 2 9
can prolong recovery times, your providers should use regional anesthesia
as the primary anesthetic or post-op analgesia whenever plausible.
Nerve blocks should especially be considered for painful lower extremity pro-
cedures such as ACL repairs and foot and ankle cases — though make sure you
also look at individual patient factors and fall risks for these cases. While single
injection nerve blocks may provide adequate analgesia as patients transition
from your facility to their homes, ambulatory catheters can extend analgesia for
several days.
Anesthesia providers are using these continuous peripheral nerve blocks
more frequently as complex orthopedic procedures, like total joints, move to
the outpatient setting. Placing peripheral catheters and starting local anesthetic
infusions can add additional costs to your cases, but they can also potentially
create savings by shortening PACU stays and keeping patients from being read-
mitted for uncontrolled pain.
Further, reported complications for continuous peripheral nerve blocks are
rare — reported infection rates are less than 1% and doses are controlled so
local anesthetic toxicity doesn't seem to be an issue. However, as mentioned
above, falls do pose a risk. Make sure you carefully select patients who will
receive lower extremity blocks and educate them on preventing falls.
It's important to couple regional anesthesia with oral medications to prevent
rebound pain. A patient who receives a 12-hour block may feel great when he
first heads home, but as the block wears off, the pain can send him on a late-
night trip to the ER. Instead, instruct patients to start their medication regimen
while the surgical site is still numb, making the transition from blocked to sen-
sate extremities more comfortable.
4. Don't forget the ice
One cheap, easy, safe — and underrated — way to reduce pain and inflamma-
tion is by using cryotherapy, or cold therapy. Cryotherapy has been studied and
