Interscalenes with Depo Medrol to enhance block duration.

[sevoflurane]

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I heard about a patient who suffered a stroke after bupivacaine with depomedrol was injected into the vertebral artery during an interscalene block. Using a particulate solution close to those vessels has unique risks.

I think that if you are going to use it, PF Decadron is the way to go. That being said, vertebral a. injection is pretty tough to do with USD.
Thx for the case report.

 

[BLADEMDA]

i do 35-40cc 0.5% ropi quite frequently. im questioning the step down in dose regarding duration of block. i understand the potential benefit to decreasing concentration but id think you would keep dose the same. just my thoughts

regarding 3-d spread in a 2-d view, its just not very sensitive. yeah we all like to see it, but you usually know after 5 cc are in and im not sure the last 5cc are that important

I stopped doing high volume blocks ten years ago. Now I use 20-25 ml's for ISB block duration is the same as high volume. Ditto for femoral and sciatic blocks. The only high volume blocks I do now are transarterial axillary and lumbar plexus.
I started adding Decadron and so far I am impressed

 

[sevoflurane]

I started adding Decadron and so far I am impressed

🙂

I haven't used it much outside of ISB's. It def. works. I'd like to see a study done with low dose LA and decadron for TKA/THA... end points being analgesia duration and quad weakness/distance walked POD 0.

 

[ssmallz]

Can you guys believe there are emergency physicians who are doing peripheral nerve blocks in the ED? They go to a weekend course at their conferences and "learn" this. Anesthesiologists are among the teachers.

I don't have a problem with this. ED docs are physicians with their own malpractice insurance if something happens then it's on them. Secondly, they are doing these procedure for different types of patients than we are, non surgical patients. They aren't goin to be coming up to the OR and stealing our blocks and I don't want to go down and do blocks for the ED pts.

Let's be honest, doing basic blocks like ISBs and Femorals isn't rocket science. ED docs have a strong foundation in ultrasound b/c they do belly scans all the time. As long as you understand the risks and can manage the complications I don't see the big deal. ED docs can certainly handle LA tox and manage an airway in case they need to.

 

[NigerianMD]

any update on anesthesia at downstate? how is it now??

 

[Pacman27]

I heard about a patient who suffered a stroke after bupivacaine with depomedrol was injected into the vertebral artery during an interscalene block. Using a particulate solution close to those vessels has unique risks.

I agree with refraining from injecting any particulate steroids. Decadron, use it in patients you would feel comfortable giving it by IV and dont use it in patients you normally would not give it to by IV.

 

[Planktonmd]

yeah blade you were thinking of ethylene glycol or propylene glycol

No he wasn't thinking, Just copying and pasting

 

[Idiopathic]

Can you guys believe there are emergency physicians who are doing peripheral nerve blocks in the ED? They go to a weekend course at their conferences and "learn" this. Anesthesiologists are among the teachers.

with that said, they do it to reduce fractures and dislocations, and with a block they could avoid sedation. i also dont see any anesthesiologists jumping at the chance to go do these blocks for them.

is it really a problem if they practice safely and understand/can manage the complications?