as 6 to 8 mls of local anesthetic can still have a positive effect on
patients' post-op pain while minimizing side effects such as phrenic
block. Also, consider that the smaller nerves, such as the saphenous
nerve in the adductor canal may not need as much as your popliteal sci-
atic block. Choosing the volume and concentration of local specific to
the patient procedure and risk factors is an important concept to adopt.
Drawing up 2 20-ml syringes of 0.5% of ropivacaine just because that is
what has always been given is a way of the past.
16. Nobody still uses nerve stimulators. Nerve stimulation is
not extinct. Use it to help you make sure you're at your target but use
it to avoid being close to what you want to avoid as well. Nerve stimu-
lators are valuable in a dual guidance plan of care where the provider
is using ultrasound as well. The stimulator allows you to check to see
that you are near the nerve you want but can also help you avoid hit-
ting nerves that may be in your needle's path, or get too close to the
epineurium, putting your patient at risk for nerve injury.
17. I've heard continuous catheters won't stay in place.
Skin sealant is worth the money. Continuous catheters are an invest-
ment on the providers' end to have placed. They take longer and require
more from the care team. Once you have effectively placed one, make
sure it stays. There are numerous products on the market that you can
use to ensure that your catheter does not dislodge before you are ready
for it to be removed. As an added bonus, a lot of these sealants also
decrease the pesky leaking your patients might otherwise complain
about.
18. If we perform a block, we can't give general. RA vs. GA:
It doesn't have to be one or the other. Although it's nice to have the
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