Full disclosure, I dont do tetracaine spinals, was just pointing out that would make them never ever hurt in PACU. One of my surgeons asks for this because he feels it gives the fluid time to reabsorb, but just because he asks for something doesnt mean he gets it. We tried a few times and they sat around for 6 hours then felt miserable, got a ton of meds for 2 hours then either went home a bit uncomfortably or stayed overnight. I would not recommend this approach. I guess that is the issue with not being able to use a sarcastic tone on the internet.
I do GA most often with basically original poster cocktail, minus the LP block, and some narcotics. Bup spinals with moderate propofol works very well with my surgeons, but is kind of a pain with positioning.
If they hurt in PACU to the point where we are considering keeping overnight, I will do a fascia illiaca block. This takes away 40-60% of their pain, and the point of doing it as a rescue block is purely to make them comfortable enough to go home. I probably do this less than 10%.
I toyed with pre-emptive fascia illiaca for these, and basically because they still had pain the patients were just as likely to "need" further care as without. On a rescue basis I am 100% for having them comfortable enough to go home.
