Blocks and Tourniquet Time

[Noyac]

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What is your cutoff for tourniquet time and blocks?

Here's the situation and I don't need any sympathy for you guys here. I'm well adjusted to the situation. But we have a orthopod that does total knees in 4 1/2 hrs. His tourniquet times are 120 mins and 90 mins. He drops the tourniquet for 20-30 min. He is the nicest guy in the world but his cases are too long. So I told him I was not going to put any FNB's in his pts b/c if his tourniquet causes nerve injury I am not taking the blame. He is fine with that but I thought it would make a good discussion. I still do a spinal with duramorph or dilaudid. His times are not over the 120 min mark at any one time but still that is a lot of tourniquet time and I have already seen one case with tourniquet induced RSD (or CRPS typeII for you pain guys).

 

[fastosprintini]

hmm, is there maybe a peer review board that has a look in his skills...?
i'd be , as you said very hesitant with any regional techniques besides contious spinals. i understand he is the nicest guy , but 4,5 hrs tkr is poor in my humble opinion... fasto

 

[militarymd]

I would agree with your approach

 

[jetproppilot]

But we have a orthopod that does total knees in 4 1/2 hrs.

😱

Agree as well, Noy.

 

[Tenesma]

he does both knees in 4.5 hours or just one knee in 4.5 hours???

dude - i wouln't do a spinal (unless they anti-coagulate heavily post-op) - instead would do an epidural w/ a single shot of dura morph and then run a bupivacaine drip and do an ETT.

the tourniquet argument is fair - would avoid the FNB. What you could offer on the flip side is an iliacus catheter that you dose after doing a neuro exam in the PACU (also dependent on how heavy the orthopods anti-coagulate).

I just hope you are working in an academic environment because this ortho guy would wilt away the profits in a private practice setting.

 

[Noyac]

I know 4.5 hrs is awful. Thats why I asked for no sympathy b/c I have come to terms with it and I am beyond it. It took about 2 yrs of intense psychotherapy to get past it and now I am coping with it just fine.





I put the locums in his room! 😀

 

[hokie]

An orthopod at my gig did 8 total knees on Tuesday (not unusual for him) - we give him two rooms (his PA closes while he starts the next one). He's usually done by 3.
I think I'd be more worried about sciatic nerve injury with those times but I probably would still put in a femoral catheter and not dose it until verifying function after the case (or just skip it entirely and do epidural DepoDur).

 

[jetproppilot]

An orthopod at my gig did 8 total knees on Tuesday (not unusual for him) - we give him two rooms (his PA closes while he starts the next one). He's usually done by 3.
I think I'd be more worried about sciatic nerve injury with those times but I probably would still put in a femoral catheter and not dose it until verifying function after the case (or just skip it entirely and do epidural DepoDur).

nice post.