2 0 S U P P L E M E N T T O O U T P A T I E N T S U R G E R Y M A G A Z I N E J U LY 2 0 1 7
1. Inform patients
Make sure patients know what to
expect after blocks are placed. If
you fail to do that, you're unlikely to
succeed with your program. Telling
patients that their pain may still be
at a 2 or 3 — and not a zero — is
crucial. "Oftentimes the initial block
has a higher concentration of med-
ication that lasts 18 to 24 hours,"
says Mitchell Fingerman, MD, an
associate professor of anesthesiolo-
gy at Washington University School
of Medicine in St. Louis, Mo. "The
block will wear off and the pain
pump will take over. Patients will experience pain relief, but not at the same
level as the initial block. If you don't explain that, they'll think the pain pump
isn't working."
Patients might also experience pain outside of the areas covered by the block.
For example, says Dr. Fingerman, patients who receive interscalene nerve
blocks for labral repairs could experience some pain in the posterior area of the
joint. After arthroscopic procedures, fluid can seep into tissue, causing joint
pain where the block doesn't reach. Make sure patients are aware of this possi-
bility.
It's best if patients are introduced to the concept of a continuous nerve block
before the day of surgery. Provide your surgeons with information and talking
points they can share with patients in the clinic or review how blocks work with
patients who come to your facility for pre-op assessments.
"If the day of surgery is the first time they're hearing about the block, and they
aren't aware of its benefits or how to take care of it post-op, they may be
Catheter-over-needle
technology reduces the risk of
leakage and makes it easy
to see the catheter on the
ultrasound screen.
