Local Anesthetic Toxicity in ERAS?

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The only reason the hospital is able to save a penny on this



is because it has an army of free labor in the form of residents. Try this at a private hospital where people actually expect to get paid for the work they are doing and the hospital would be hemorrhaging money in personnel costs in order to save on that one hospital day LOS.

I think it's cool that this has been a success at your institution but it's just not practical in most settings. I think it's potentially dangerous when all the services - especially floor nursing are not on the same page.

Completely agree.


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It really depends on how good your nursing is on the floors. Our nurses struggle even with PCA's. The thought of them being in charge of running local anesthetic infusions through an IV scares the dickens out of me.
 
With the combination of pre-op blocks, pre-op Gaba/Tylenol, lido + ketamine infusions intraop, lido infusion post-op x24hrs, and post-op scheduled Gaba/Tylenol TID (+/- Toradol), I have seen patients have major abdominal operations and require zero perioperative opioids. Like no opioids intraop, and none post-op through to discharge. And they have them available PRN. Also, the implementation of these ERAS protocols has without a doubt (very robust IT/informatics branch of the department) shown to decrease rates of post-op ileus and decrease hospital LOS almost 1.5days

Are your "pre-op blocks" for "major abdominal surgery" thoracic epidurals? If so, why bother with all the other crap?

And to pile on, yes this is a totally/ridiculously labor intensive way to save a few milligrams of hydromorphone. That's like, what, 1 FTE per 10mg hydromorphone saved per week
 
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Are your "pre-op blocks" for "major abdominal surgery" thoracic epidurals? If so, why bother with all the other crap?

And to pile on, yes this is a totally/ridiculously labor intensive way to save a few milligrams of hydromorphone. That's like, what, 1 FTE per 10mg hydromorphone saved per week

Sometimes yes, sometimes no. Obviously people with epidurals don't get the lidocaine infusions, although I have seen them used quite effectively as transition therapy for hyperalgesic patients on TEC discharge day.

Again, not my brainchild. Just sharing.


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My PD always said, never publish your f-ups. Who gives 40ml of . 375ropi to a 40kg pt? That's toxic dosing! Again, I'm not against putting whatever you want in your block. I'm just saying it's not necessary if you stay inside normal dosing. And putting epi in and then going way over dosing wouldn't save you at all in court. Just sayin...

Yup... not sure what this report is exactly trying to get at. Don't be dumb?

I remember as a resident sitting in the audience listening to some of my co-residents and attendings present their poster presentations that were accepted by the ASA for the annual meeting, and thinking, "How was this accepted?! It's like basic anesthesia stuff." It's like they did something dumb, researched it, found out it was dumb, and then presented it with the conclusion "Don't do dumb stuff!"

Or they would encounter a rare disease (which was known) and being an academic hospital they would look the case up the night before, find a case report about it, then proceed to do the same thing that the case report told them to do. The patient would "amazingly" survive cause they would be smart and do an awake FOI (or whateer is pertinent to that patient), and they would then publish THEIR case report with the same exact background info and plan and strategy to deal with this rare thing. So essentially the whole presentation was we had a patient with Joe-Schmoe disease. This is a rare disease. We found 2 case reports of other patients with Joe-Schmoe disease where they recommended X, Y, Z. We did X, Y, Z and the patient didn't die. In the rare case you have a patient with Joe-Schmoe disease you should also do X, Y, Z... Brilliant!

Or they would experience a complication, which was treated successfully (usually) and then make a poster about said complication and how to treat it. The ASA/ABA loves safety stuff, so they always seemed to accept **** like that. Like how many cases of MH and giving dantrolene can be presented every year? There's an algorithm. There's a hotline. It's rare as ****, but probably has the highest ratio of certification questions per actual events of any anesthesia complications. To quote a famous song... "If you don't know me by now... You will never never never know me..."
 
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