Less neuraxials safer?

[sevoflurane]

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What do you think about local wound infusion of Ropivacaine (same "Pain buster" idea and bilateral TAP blocks plus postop Morphine PCA? I am also thinking about some new anticoagulants that are coming and perhaps these approaches will be safer than relatively blind needle manipulation close to spinal cord?

I like TAP blocks. 👍 Good choice for the smaller abd. incisions such as lap. hand assisted colectomies or hysterectomies. Add a PCA and good po meds, and these people do very well (although you may not get bowel function to return as rapidly).

As to paraplegia with an epidural placement... what does the literature say about that? Very rare NTG. Epidrural hematoma is reported to be as low as 1:200,000. Of those that do get it, I don't know which ones go onto paraplegia... but I would guess a small minority. If someone is getting paraplegia from PLACEMENT of an epidrual catheter, then they are doing something wrong, IMO.

 

[rsgillmd]

I agree with the above completely.

Good grief...Let's just tell patients they might have a stroke, their kid could become a vegetable, they could get burned by the bovie, they might have a reaction that delights the trial lawyers, etc.

I have yet to observe a patient say, "hmm, I didn't know I might die with anesthesia, I guess I won't have this operation after all."

"Hello passengers, welcome to flight 1234. Please be advised this plane could fail to deliver you to your destination, in fact, it could explode in the air and not just kill you, you may in fact survive and be an invalid and horrendously scared burn victim. Please sign the consent form before we depart. Thanks for flying with We Cover Our Butts Airlines"

🤣🤣👍

 

[tucker27705]

Everything depends on how you tell it. You may be the monster that scares everybody away, or you may be the caring, loving person that protects them.

As I said earlier, every one of my patients ends up happy that I am taking good care of them.

And as much as you may want to deny it, children are afraid of dying when they are going to have surgery. Somebody is going to cut them open and they are not going to fear? Impossible. You have to accept that they are afraid, let them know that you understand their fears, not dismiss them as if they were the delusions of a crazy or ignorant person, recognize that the danger is real and reassure them that you will take good care of them and they are going to be better than they are now.

If you think children don't know what is going on and lie to them, they are never going to trust you again. Don't lie to them about dangers, don't lie to them about pain, don't lie to them about the smell of the mask, don't lie to them about what you are going to do to them, don't lie to them about anything. They are people: they deserve the same respect as the adults.

I doubt very much that you have children. I have two boys, and they had minor surgery this year. If someone had told them 10 minutes before going to the operating room that they might die (5 and 6 years old at the time), I would have chewed their asses. There is no way that is appropriate. You don't say that and then say they could die by getting in the car. That may sound like a reasonable thing to you, but not to a little boy who is already scared.
You are just plain wrong.