of fluid through it, you'll increase the force that the liquid exits the
needle.
It's like comparing the different sized holes on your showerhead.
The water stream that comes out of the smaller holes tends to sting
you more than a wider water stream. This can cause serious nerve
damage if you have your anesthetic exiting the needle faster than it
should. It can cause damage to the external structures of the nerve.
The manometer also prevents intraneural injection by limiting overall
injection pressure. Most manufacturers limit the exiting pressure to
less than 15-20 psi.
5. Monitoring
Then there is the thing you don't want to think about happening but
you have to be prepared for — local anesthetic systemic toxicity
(LAST). This is why you must continually monitor the patient while
performing your procedures. If an inadvertent intravascular injection
occurs, the signs and symptoms of LAST will be obvious on a moni-
tored patient. The anesthetist and block nurse monitor the patient's
EKG, blood pressure, pulse oximetry, and respiration before the block
begins and every 5 minutes for 30 minutes afterwards. You should
also have 20% lipid emulsion in your block cart so you can quickly
grab them if your patient starts showing signs of LAST and then fol-
low ACLS. The initial dose of 20% lipid emulsion is 1.5mL/kg.
6. Reduce post-op infection
Here is where you can have some fun and add your own personal
touches to your nerve block regiment if you're sending patients
home with catheters. Since the catheter is going to remain in the
patient for 2 to 3 days, there are risks for post-op infections at the
insertion site. Here is what I do to make sure that the site stays
7 4 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M A Y 2 0 1 8
