Most interesting regional block you've done?

[ethilo]

Just curious if anyone out there has some interesting (creative blocks) and/or successful regional anesthesia experiences.

One that surprised me - we did bilateral SS adductor canal blocks last week on an old lady who couldn't walk pre-op due to pain from severe OA. We (the regional team) were hanging out chatting in the PACU a couple hours later and guess who walked by us with PT and a walker about 30 minutes post-op, smiling and waving at us?...

My jaw dropped. Ok, I'm a little new to regional anesthesia but that was amazing. Never thought it'd be that striking of a result.

---

Members don't see this ad.

 

[criticalelement]

all in one block is my favorite

 

[Urzuz]

all in one block is my favorite

You must be referring to the head-to-toe spinal!

 

[Ezekiel2517]

Just curious if anyone out there has some interesting (creative blocks) and/or successful regional anesthesia experiences.

One that surprised me - we did bilateral SS adductor canal blocks last week on an old lady who couldn't walk pre-op due to pain from severe OA. We (the regional team) were hanging out chatting in the PACU a couple hours later and guess who walked by us with PT and a walker about 30 minutes post-op, smiling and waving at us?...

My jaw dropped. Ok, I'm a little new to regional anesthesia but that was amazing. Never thought it'd be that striking of a result.

Yes blocks are great, until they wear off. So cruel, like giving a blind man sight for a day

 

[Planktonmd]

Yes blocks are great, until they wear off. So cruel, like giving a blind man sight for a day

Hopefully you will not be there when they wear off... unless you are part of a surgical home then you are really screwed!

 

[deleted162650]

Yes blocks are great, until they wear off. So cruel, like giving a blind man sight for a day

That's why I do all my blocks with phenol.

 

[dhb]

Pudendal bloc is my fav

 

[norwood]

Yes blocks are great, until they wear off. So cruel, like giving a blind man sight for a day

?? - 1st day after surgery is the worst. What's wrong with helping people get through it?

 

[BLADEMDA]

Shoulder block for a patient with severe COPD on home oxygen. The block worked quite well.

http://www.nysora.com/newsletterz/j...ircumflex-nerve-block-the-shoulder-block.html

 

[PainDrain]

I did bilateral paravertebral blocks for double mastectomy on a woman with significant IVDU hx who wanted no opiates post-op. She did great and it was a very gratifying case.

Yes blocks are great, until they wear off. So cruel, like giving a blind man sight for a day

It isn't cruel if you tell the patients that the block duration is X number of hours and despite having no pain they will have pain when it wears off; therefore take the pain medication ordered by your surgeon regardless.

 

[BLADEMDA]

I did bilateral paravertebral blocks for double mastectomy on a woman with significant IVDU hx who wanted no opiates post-op. She did great and it was a very gratifying case.



It isn't cruel if you tell the patients that the block duration is X number of hours and despite having no pain they will have pain when it wears off; therefore take the pain medication ordered by your surgeon regardless.

I've done a paravertebral block on a woman having an open thoracotomy. I used exparel and she did not have any pain or require any pain meds for 36 hours.

 

[sevoflurane]

For me, it's any case where you are rounding the next day and thinking to yourself... dang... that should really, really hurt, even with a good 'ol xxx block/epidural. And here you are the morning of POD #1 and still not hurting. I find this a fascinating aspect of anesthesia.

Pelvic exenterations with abdominal flaps/pull throughs come to mind.

 

[OB1🤙]

I always got a kick out of high thoracic epidurals for VT storm. Did a handful in residency.

 

[deleted9493]

Subcostal TAP block on premies getting open gastrostomy tubes. .1mg/kg of PF decadron in the mix and some of them will go their whole postoperative course without getting anything for pain.

 

[dhb]

VT storm.

What's that?

 

[Consigliere]

Nothing clinically related but this dude cock blocked me at the bar pretty tough last night.

 

[OB1🤙]

What's that?

Incessant ventricular tachycardia

 

[PainDrain]

I always got a kick out of high thoracic epidurals for VT storm. Did a handful in residency.

I actually had to look this up also. Apparently epidural and spinal have been used to decrease sympathetic outflow and to decrease the recurrence of VT in patients susceptible to this condition. Part of the issue is these patients go into VT, are shocked out of it which increases sympathetic response and then triggers another attack. Cool scenario.

 

[deleted162650]

I actually had to look this up also. Apparently epidural and spinal have been used to decrease sympathetic outflow and to decrease the recurrence of VT in patients susceptible to this condition. Part of the issue is these patients go into VT, are shocked out of it which increases sympathetic response and then triggers another attack. Cool scenario.

Cool indeed. So once you have a good functioning epidural in place, what's next? They go for ablation I'm guessing?

 

[sigrhoillusion]

I want to get the block that every surgeon seems to get on the surgeries they perform on their patients which according to the surgeon "doesn't really hurt that much"... Cause it seems like every surgeon I talk to ensures me that THEIR surgeries NEVER hurt that much and shouldn't require much pain meds. I need to figure out which magical block they are using...

 

[Planktonmd]

I want to get the block that every surgeon seems to get on the surgeries they perform on their patients which according to the surgeon "doesn't really hurt that much"... Cause it seems like every surgeon I talk to ensures me that THEIR surgeries NEVER hurt that much and shouldn't require much pain meds. I need to figure out which magical block they are using...

Surgeons are the last standing monument of what medicine used to look like in the good old days. They are still taught that they are the captains of the ship! and that everyone should just worship them because they are God's representatives in the OR and everywhere else in the hospital.
Unfortunately for them they are being increasingly humbled by the fact that physicians are no longer the leaders they used to be, and that if you want to make a living in medicine these days you'd better understand that this is a business controlled by administrators, and you need to kiss their asses if you want to survive.
So as a defense mechanism they try to hold on to whatever illusion of control they might have, and that's what explains their grandiose view of their skills and their God like abilities.

 

[OB1🤙]

Cool indeed. So once you have a good functioning epidural in place, what's next? They go for ablation I'm guessing?

Ablation, as well as bilateral thoracoscopic sympathectomy. The epidural was seen as diagnostic and therapeutic, in that if it did suppress the VT, they'd probably respond favorably to surgical sympathectomy.

 

[Ashers]

I want to get the block that every surgeon seems to get on the surgeries they perform on their patients which according to the surgeon "doesn't really hurt that much"... Cause it seems like every surgeon I talk to ensures me that THEIR surgeries NEVER hurt that much and shouldn't require much pain meds. I need to figure out which magical block they are using...

Well, the procedures don't hurt the surgeon.

In my fellowship (regional and acute pain), the surgeons thought something was wrong if a patient didn't get a block (eg. patient refusal). In my residency and current practice, I have to convince several of the surgeons to allow a block when I think it is worth it.

My dad's an orthopaedic surgeon, after his shoulder surgery with a block, he started asking for blocks for all his patients who could get them, and was an early adopter of regional for a lot of his cases.

 

[sigrhoillusion]

'My dad's an orthopaedic surgeon, after his shoulder surgery with a block, he started asking for blocks for all his patients who could get them, and was an early adopter of regional for a lot of his cases."


Exactly, that's my point. Surgeons seem to think surgeries don't hurt despite the fact that they have never actually had that surgery done on themselves. Even some of my attednings from residency used to be the same way. "Don't give XXX narcotic cause this doesn't hurt that much." Really? You sure about that?

I mean I'm all for blocks, and multimodal analgesia, but you'd think these surgeons would realize that the gas wears off in the PACU... I mean I don't care how small all those lap trochar incisions are, if someone stabs you in the guy with a blade, it's going to hurt.