What do you wish surgeons knew about anesthesia?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Thanks for clarifying regarding potency. The thought process regarding vicodin vs morphine is that I would be giving 5mg of vicodin for tourniquet pain, use the local block for surgical site analgesia, and thereby avoid 10mg of morphine which was actually given recently to one of my patients resulting in urinary and shortness of breath symptoms after discharge. Just trying to better understand how to prevent post op analgesia complications, thanks again for all of your help, my apologies for any offensive remarks.

Members don't see this ad.
 
Thanks for clarifying regarding potency. The thought process regarding vicodin vs morphine is that I would be giving 5mg of vicodin for tourniquet pain, use the local block for surgical site analgesia, and thereby avoid 10mg of morphine which was actually given recently to one of my patients resulting in urinary and shortness of breath symptoms after discharge.

Your 5 mg Hydrocodone dose (Vicodin) is in the same neighborhood of efficacy as the 10 mg of morphine. Some patients are just sensitive. Do I personally use morphine for those cases? No because it hangs around for a long time, though so does hydrocodone. I stick to fentanyl if I need any opioid since it goes away much faster.
 
Tourniquet pain can be a challenge to treat even for anesthesiologists, and it's impossible to prevent in many patients. The best antidote is a fast procedure (and most podiatry cases don't qualify). The only way I can see this done under local is without a tourniquet.

Bolusing 10 of morphine to an elderly patient is inexcusable. The solution is to try to find a good anesthesia team that you enjoy working with, and make sure you request them every time. Surgeons tend to think that MAC is easy, but it can require more work and experience than general anesthesia, so you'll want somebody well-versed in it.
 
  • Like
Reactions: 1 users
Members don't see this ad :)
Thanks for the replies. I am still trying to answer whether it is appropriate for me to take the approach of "this is my patient, I prescribe the postop meds and will handle the pain after the case, please don't give 10mg morphine after I have given a block and please don't give toradol as my post op protocol includes ibuprofen 400mg every 6 hours and my block will last as long as toradol anyway" versus "I'm just the surgeon and anesthesia is your domain and I won't tread on your territory."
If you aren't going to deal with the patient in the PACU yourself, and you're not, a suggestion like "try to limit opiates" is probably enough.
Don't be closed minded to multi modal analgesia. It's a good way to limit opiates for one, and it can smooth out the post op course. It's not as simple as DC to home in an hour and start home meds when block is wearing off. If you ask to limit opiates and they are shotgunning 5-10 mg at a time, vs titration to effect that's a new problem.
0.5 mcg/kg of Precedex 30 min before wake up might smooth your .mil potential PTSD patients with minimal post op discharge delays. Suggest that instead of opiates.
PS fentanyl is actually a better drug for you as it is easier to titrate than morphine for tourn pain, etc and is more forgiving than morphine if they are a little heavy handed. Your lack of understanding anesthesia is becoming more apparent.
Feel free to do the cases alone with a Tylenol and Music if you want, but your patients will be the losers.
Communication is the key to smooth things out, explain what you want, and then you have to trust that the anesthesia experts actually know what they are doing with regards to anesthesia.
PPS perhaps the morphine did cause your patients post op issues, but unless they gave a dose of narcan and things suddenly got better, there's really no proof that was the cause. Though 10mg in an elderly patient sounds excessive if given as a bolus.
 
Last edited:
Communication is the key to smooth things out, explain what you want, and then you have to trust that the anesthesia experts actually know what they are doing with regards to anesthesia.

This x1000. If you (podiatrist) want to handle PACU pain issues, you are more than welcome to, but I'm guessing you are like the majority of your surgical colleagues and don't want to be hammer-paged in the OR to deal with the inevitable pain issues from the "5mg of vicodin for tourniquet" plan from the previous case.

Another thing to consider is that if you've communicated your plan/concerns with the CRNA and they're still making the same mistakes, you can also try to arrange to work with anesthesia providers who know/understand you better, assuming scheduling permits.
 
Top