Maverikk

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Would this be useful, surgeon inquired about it and it seems like it would cover the area and reduce the need for as deep sedation when you have a surgeon who doesn't localize well. I was thinking mepivacaine for speed of onset and procedure. Thoughts?
 

BLADEMDA

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BLADEMDA

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Maverikk

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PECS1 would work too, probably better coverage but interscalene should cover C5, it would be the C4 that would be the problem...probably needs less local by the surgeon either way
 

BLADEMDA

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PECS1 would work too, probably better coverage but interscalene should cover C5, it would be the C4 that would be the problem...probably needs less local by the surgeon either way

Ultrasound Guided PECS Block PECS 1 Blocks:
• Median pectoral nerve(C8,T1)
Lateral pectoral nerve(C5,C6,C7).
Blocked between Pectoralis Major and minor
 

SaltyDog

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surgeon inquired about it and it seems like it would cover the area and reduce the need for as deep sedation when you have a surgeon who doesn't localize well.
This is definitely in the running for most ******ed idea of 2016.

It would actually be winning if it wasn't for the presidential election this year.
 

Mman

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PECS1 would work too, probably better coverage but interscalene should cover C5, it would be the C4 that would be the problem...probably needs less local by the surgeon either way
sure less local by the surgeon after you already injected a bunch of local.

How bad is the surgeon that they want a nerve block for a port? I mean it's a central line with a little tunnel and a pocket. Putting an IJ in an even mildly sedated patient is not difficult, hell it isn't difficult in an unsedated patient.
 

soorg

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Unbelievable overkill. Why not do a spinal for a pinky toe amputation while you're at it?
 

SaltyDog

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Unbelievable overkill. Why not do a spinal for a pinky toe amputation while you're at it?
I think it's more akin to placing a cervical epidural for post-thyroidectomy pain control ;)
 

kidthor

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Yeah IS for a mediport sounds stupid. PECS is semi reasonable but really overkill when they can just field block and be done with it.

On the upside, at least your surgeon is into blocks as a concept...
 

sigrhoillusion

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Def seems like overkill. Is the goal to avoid all sedation? Outside of difficult airways, an IS would be relatively contraindicated in someone you might want to avoid sedation like a severe COPDer
 
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Maverikk

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Definitely overkill, I did like that they realized the advantages to blocks..Don't think I'd do it though, seems like a procedure that risks/benefits don't weigh out given they can just use local
 

sigrhoillusion

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While you're at it, why don't you recommend a high spinal and ETT? That should cover any procedural pain... :claps: