B/L intermediate cervical plexus blocks

[turnupthevapor]

For a thyroid is B/L intermediate cervical plexus blocks a bad idea?

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[woopedazz]

Yes

 

[patriot6]

1mg hydromorphone instead.

YW

 

[Lecithin5]

Absolutely bad idea

 

[Justice4all]

Why??????????
Abs NO

 

[pgg]

For a thyroid is B/L intermediate cervical plexus blocks a bad idea?

🍿

 

[sevo00]

Is this a joke

 

[Iso4ane]

Perform bilateral cervical plexus blocks….
Some time later….

 

[turnupthevapor]

1mg hydromorphone instead.

YW

Looks like no benefit

The Bilateral Superficial Cervical Plexus Block With 0.75% Ropivacaine Administered Before or After Surgery Does Not Prevent Postoperative Pain After Total Thyroidectomy | Regional Anesthesia & Pain Medicine

 

[turnupthevapor]

Is this a joke

 

[Iso4ane]

FYI, some people differentiate between a superficial and an intermediate cervical plexus block and some don’t. For a true superficial probably okay, but for the intermediate, I would argue that’s questionable.

 

[coffeebythelake]

Do your pts hurt that much with thyroid they need a block or even dilaudid? Our surgeon infiltrates local for postop pain and we do a small touch of fentanyl

 

[Lecithin5]

Do your pts hurt that much with thyroid they need a block or even dilaudid? Our surgeon infiltrates local for postop pain and we do a small touch of fentanyl

Similarly, we have a vascular surgeon that wants cervical plexus blocks for his GA carotids, and it kind of pisses me off

 

[coffeebythelake]

Similarly, we have a vascular surgeon that wants cervical plexus blocks for his GA carotids, and it kind of pisses me off

Totally unnecessary unless he wants to do awake technique

 

[turnupthevapor]

FYI, some people differentiate between a superficial and an intermediate cervical plexus block and some don’t. For a true superficial probably okay, but for the intermediate, I would argue that’s questionable.

I think Nash and colleagues disproved the impermeable fascia idea

 

[FiO2@21]

Similarly, we have a vascular surgeon that wants cervical plexus blocks for his GA carotids, and it kind of pisses me off

I think these are great for surgeons who don’t use local properly.

Had a very nice prompt wake up with 0.1ish of precedex and 0 narcotic.

 

[coffeebythelake]

I think these are great for surgeons who don’t use local properly.

Had a very nice prompt wake up with 0.1ish of precedex and 0 narcotic.

Ehh the smooth wake up has more to do with preventing bucking on the ETT than anything else.

 

[FiO2@21]

Don’t disagree, one of the few cases I use an LTA for.

 

[patriot6]

Do your pts hurt that much with thyroid they need a block or even dilaudid? Our surgeon infiltrates local for postop pain and we do a small touch of fentanyl

Minimal pain, but I like hydromorphone for tube tolerance at the end of the case.

 

[Maz777]

Why not just do bilateral phrenic nerve blocks? You’ll get great analgesia as they go to the ICU intubated and sedated. Hospital can bill for ICU level of care and a prolonged admission, and you get your 1.7 extra wRVUs to pay for your steak dinner. Jackpot.

 

[coffeebythelake]

Minimal pain, but I like hydromorphone for tube tolerance at the end of the case.

ehhh so many different ways to achieve this,
but my point stands, this is not a type of surgery where patients have lot of postop pain

 

[Urzuz]

Similarly, we have a vascular surgeon that wants cervical plexus blocks for his GA carotids, and it kind of pisses me off

Why does it piss you off? Easy block, patient doesn’t need opioids postoperatively, and you get to bill for a block. What’s not to love?

 

[Lecithin5]

Why does it piss you off? Easy block, patient doesn’t need opioids postoperatively, and you get to bill for a block. What’s not to love?

Correct- it is easy. But still requires time to pull drugs and program ultrasound etc- our block/pain service is extremely busy as it is. And it’s an unnecessary block- either local infiltration or a landmark plexus block by either the surgeon or anesthesiologist is probably just as effective. And brings it in probably 50 bucks to our practice (I’m guessing)…