a way that the
provider can perform
the block ergonomi-
cally and best visual-
ize the nerve and
place the needle. You
also want to consider
patient safety factors
such as their airway
being accessible and
cardiac monitors in
view.
14. There's nothing you can do about rebound pain when
single-shot blocks wear off.
First off, yes, rebound pain is a
common yet underappreciated phenomenon that happens when a
single-shot nerve block wears off. The pain is often so severe that it
results in higher pain scores and higher opioid use in patients at the
24-hour mark than in patients who received no block at all. Rebound
pain occurs commonly in such surgeries as wrist fractures, shoulder
repairs and ankle repairs. However, continuous perineural catheters
can significantly decrease this by controlling pain for days following
these procedures.
15. I'll need a lot of local anesthetic for a successful
block.
Neither high volume nor high local anesthetic concentration is
needed for a successful block. Less can be more. Consider lower vol-
ume and/or lower concentration when working with patients who
may require an interscalene block but who have a history of mild to
moderate COPD, for example. Practice is showing that even as little
O C T O B E R 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 5 7
• MEDICAL EMERGENCY In cases of local anesthetic systemic toxicity, make sure
each day the lipids are accessible — either on the ultrasound machine or on top of
Heather
Black
from
Barnes
&
Co.
