I had a hand model the other day re-iterate to me not to place an iv in her hand (gotta admit- she had nice hands!). We’ve heard of professional singers not wanting to be intubated if at all possible. Any other interesting things that you guys have come across along these lines?
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Hand model
Started by Lecithin5
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Sure no problem, As long as they are ok being stuck multiple times in other places that may not have nice palpable veins.
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deleted87051
This thread is worthless without pics.
But along these lines, I try not to tape obviously false eyelashes and use the Dupaco optigard instead.
But along these lines, I try not to tape obviously false eyelashes and use the Dupaco optigard instead.
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deleted875186
certainly wouldn’t nerve block a professional athlete.
Can't do the hand? Pedi guy (putting tourniquet above saphenous): "Hold my beer"
I guess conversion to chronic pain is better than some cooked up theoretical risk of nerve injury?
Not sure about cooked up theoretical risk. Seems like if the surgeon screws up they have a way to share the blame by saying it is nerve injury from the block. Such lawsuits exist. For example Sharrif Floyd and his $180M lawsuit.
I put a piece of gauze over and tape it.
Or ending a career of a promising young athlete that could be worth millions?
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deleted162650
Or just put the tape over the eyelid only, not over the lashes.
definitely not theoretical
While a random office worker might not notice a teeny change in sensation or strength in their hand after an upper extremity nerve block, to someone like an MLB pitcher that might be the difference between them being paid millions of dollars a year or being out of the league. We talk about risks with nerve injury in terms of permanent significant deficits. Those are rare. But subtle deficits are probably a lot more common than we realize and potentially impactful to some patients.
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deleted87051
Is there any evidence that nerve blocks reduce the incidence of chronic pain after surgery?
For amputations yeah
Not too many amputees in the majors.
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deleted875186
There is very little evidence that blocks actually reduce persistent post surgical pain, as much as we like to toot our own horns.
Epidurals preemptively before amputations, the rest is a wash. But the incidence of persistent pain after a amputation is very hight to begin with.
I remember reading an article that showed that good pre-op pain control via morphine, block or epidural reduced persistent pain post op equally in each group.
One of the major factors that determines pain post amputation (phantom pain) is pre operative pain severity and length of time. If someone has been dealing with an injury for months to years and then opts for amputation then they are almost definitely going to have phantom pain, likely severe. This makes sense considering the theory that chronic pain is due to a combination of neural reinforcement that occurs in the spinal cord and at higher cortical levels. Interestingly, I recently read that children who have limbs amputated during infancy or who are missing limbs at birth can have phantom sensations and pain. That means some of this neural circuitry is present at cortical levels and is much more complex then we had ever realized.
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deleted162650
One of the more interesting phenomenons I’ve heard about was listening to Dan Crenshaw describing his phantom vision after being temporarily blinded (permanently in 1 eye) from taking an IED to the face.
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deleted87051
I don’t have any experience treating and following these patients long term but mirror therapy is interesting too.
Mirror therapy is definitely interesting and shows promise. Seen some good results with CRPS.
