Blocks for cases involving nerve transposition

[okayplayer]

Curious how you guys handle this scenario I’ve seen a few times.

Surgeon requests a postop block for case involving ulnar nerve transposition. (Postop because the surgeon wants to examine in PACU)

If the surgeon documents an exam postop would you do a block or would you decline on grounds that you don’t want a potential complication being attributed to the block?

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[coffeebythelake]

Curious how you guys handle this scenario I’ve seen a few times.

Surgeon requests a postop block for case involving ulnar nerve transposition. (Postop because the surgeon wants to examine in PACU)

If the surgeon documents an exam postop would you do a block or would you decline on grounds that you don’t want a potential complication being attributed to the block?

We do the block IF NEEDED after a neuro exam. These patients can have a ton of pain.

 

[Arch Guillotti]

Just do it.

 

[DrZzZz]

Some of our surgeons aren't concerned about doing an immediate postop check and request the blocks in preop, which we document in our notes. Others we hold off til PACU after the postop check by the surgeon. Of those, maybe half get blocked in pacu, the other half decide they're happy enough with the narcotics already on board.

 

[kmurp]

We do these cases under regional as the primary anesthetic.

 

[BLADEMDA]

Curious how you guys handle this scenario I’ve seen a few times.

Surgeon requests a postop block for case involving ulnar nerve transposition. (Postop because the surgeon wants to examine in PACU)

If the surgeon documents an exam postop would you do a block or would you decline on grounds that you don’t want a potential complication being attributed to the block?

I routinely block these cases preop with a Supra or Infraclavicular block. Out of the last 300 or so 2 patients were referred to a Neurologist postop. Both times the EMG showed the injury was at the level of the elbow and not high up on the brachial plexus. Both times my blocks were not the cause as documented by the Neurologist. Both patients have improved over the ensuring 12 months.

When doing Regional nerve blocks the key is to place the block significantly away from the surgical site so it is possible for the Neurologist to clearly see any injury is related to the operation. Blocks placed within 12 inches of the surgical site are very legally precarious because any postop injury will be blamed on your block.