Continuous popliteal nerve block catheter

[Ferocity]

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Could somebody explain to me the bureaucracy behind why a certain hospital doesn't do these procedures?

The pod that I shadowed performs surgery at two hospitals...

Hospital A) Level II trauma center. Uses a single shot Bupivacaine(toxicity?) popliteal nerve block. No continuous nerve block.

Hospital B) Home to one of the best pod residencies. Uses Ropivacaine and sends patients home with a continuous popliteal nerve block catheter installed.

 

[PADPM]

Could somebody explain to me the bureaucracy behind why a certain hospital doesn't do these procedures?

The pod that I shadowed performs surgery at two hospitals...

Hospital A) Level II trauma center. Uses a single shot Bupivacaine(toxicity?) popliteal nerve block. No continuous nerve block.

Hospital B) Home to one of the best pod residencies. Uses Ropivacaine and sends patients home with a continuous popliteal nerve block catheter installed.

It may simply be philosophical differences. Anytime there is a catheter/needle installed there is additional risk of complication, patient interference (pulling it out, tampering with it, etc.,) and of course infection. There are pros and cons to all procedures, and this hospital may have simply made a decision based on the cons outweighing the pros in their opinion.

 

[Ferocity]

It may simply be philosophical differences. Anytime there is a catheter/needle installed there is additional risk of complication, patient interference (pulling it out, tampering with it, etc.,) and of course infection. There are pros and cons to all procedures, and this hospital may have simply made a decision based on the cons outweighing the pros in their opinion.

So it's not a money thing (for the hospital)?

 

[347932]

So it's not a money thing (for the hospital)?

No.

 

[PADPM]

So it's not a money thing (for the hospital)?

???

 

[Ferocity]

???

I just don't understand how hospital politics work, that's all. Why would one hospital only allow the anesthesia department to use an anesthetic that has more cardiac toxicity? Also, shouldn't the patient at least have the option of being sent home with the pump?

 

[PADPM]

I just don't understand how hospital politics work, that's all. Why would one hospital only allow the anesthesia department to use an anesthetic that has more cardiac toxicity? Also, shouldn't the patient at least have the option of being sent home with the pump?

I thought I already explained that once in my first response. It's not always attributed to what you call "politics", but sometimes simply differing views or opinions. Just because I may approach a medical condition or surgical condition differently than someone else, doesn't necessarily mean it's a "political" decision, nor does it necessarily mean I'm right or wrong.

Medicine isn't always black and white and in your career you will see differing opinions on a daily basis.

 

[Feli]

When in doubt, go with EBM:

http://www.ncbi.nlm.nih.gov/pubmed/21189203

 

[Ferocity]

When in doubt, go with EBM:

http://www.ncbi.nlm.nih.gov/pubmed/21189203

Interesting.

CONCLUSION:

Despite the statistically significant findings, with such low pain scores in both groups, we believe it remains debatable whether the extra time and cost involved warrants the use of a continuous popliteal blockade over a single bolus injection.

When they say "extra cost", is this for the patient?