Patient instructions after lower extremity block in clinic

[EthylMethylMan]

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Hey all, was hoping I could get some advice about nerve blocks in the clinic setting. I’m planning to start using saphenous and superficial peroneal nerve blocks for select patients in my wound clinic. Planning to use procaine or chloroprocaine. I have experience with other nerve blocks from my emergency medicine days, but these particular ones are new to me, and I’ve never used blocks in a non-ER setting.

I’ve got three questions:

1. How long is long enough to watch these patients before sending home? I’ve seen a lot of online resources saying 30 minutes, which seems kinda long but would be doable.

2. If the patient can ambulate fine at baseline, would you allow them to ambulate before their foot/ankle sensation has fully returned? Obviously would give precautions to be vigilant of their foot/ankle until then.

3. If they have intact plantar sensation and motor function (e.g. after a saphenous block), would you allow them to drive before their sensation has fully returned?

Thanks in advance!

 

[BobBarker]

Saphenous isn’t motor. I would let them go nearly immediately. I used to keep tibial about an hour after a lido block.

 

[EthylMethylMan]

Saphenous isn’t motor. I would let them go nearly immediately. I used to keep tibial about an hour after a lido block.

My bad, I didn’t word that saphenous question well. I mean, if a patient has gotten a saphenous block, would you allow them to drive before it fully wears off? I was leaning towards it being okay because motor function and plantar sensation would be preserved.

 

[willabeast]

My bad, I didn’t word that saphenous question well. I mean, if a patient has gotten a saphenous block, would you allow them to drive before it fully wears off? I was leaning towards it being okay because motor function and plantar sensation would be preserved.

First few years in practice I let patients drive home. Admin/Med Legal found out and strictly forbid it. They were OK with a taxi or Uber if no alternative. The problem is if there is a MVA on way home, especially if no one has car insurance, deep pocket may be you or employer. But the reality was most of the MVAs occurred on their way TO my office. Anyway now you know what I know.

 

[giddyup]

Hey all, was hoping I could get some advice about nerve blocks in the clinic setting. I’m planning to start using saphenous and superficial peroneal nerve blocks for select patients in my wound clinic. Planning to use procaine or chloroprocaine. I have experience with other nerve blocks from my emergency medicine days, but these particular ones are new to me, and I’ve never used blocks in a non-ER setting.

I’ve got three questions:

1. How long is long enough to watch these patients before sending home? I’ve seen a lot of online resources saying 30 minutes, which seems kinda long but would be doable.

2. If the patient can ambulate fine at baseline, would you allow them to ambulate before their foot/ankle sensation has fully returned? Obviously would give precautions to be vigilant of their foot/ankle until then.

3. If they have intact plantar sensation and motor function (e.g. after a saphenous block), would you allow them to drive before their sensation has fully returned?

Thanks in advance!

1. 10 min
2. yes
3. no

 

[JFS]

1. Immediately
2. Yes
3. No - only because of the legal implications of an MVA

 

[Snowmen96]

Hey all, was hoping I could get some advice about nerve blocks in the clinic setting. I’m planning to start using saphenous and superficial peroneal nerve blocks for select patients in my wound clinic. Planning to use procaine or chloroprocaine. I have experience with other nerve blocks from my emergency medicine days, but these particular ones are new to me, and I’ve never used blocks in a non-ER setting.

I’ve got three questions:

1. How long is long enough to watch these patients before sending home? I’ve seen a lot of online resources saying 30 minutes, which seems kinda long but would be doable.

2. If the patient can ambulate fine at baseline, would you allow them to ambulate before their foot/ankle sensation has fully returned? Obviously would give precautions to be vigilant of their foot/ankle until then.

3. If they have intact plantar sensation and motor function (e.g. after a saphenous block), would you allow them to drive before their sensation has fully returned?

Thanks in advance!

Answer to #1 can be figured easily if you know how long the hallway to leave the clinic is and how fast the patient walks.

 

[Orin]

It's more medicolegal, but I will say I've seen sensory only nerve blocks cause motor issues with providers using high volumes. The saphenous nerve block sometimes gets the vastus musculature for example if you inject enough so while their foot is fine, the knee may be weak.

If you're doing this for wound care, unless it's a billing thing, topicalization or Nitronox could be easier/less stress, but if you must do the block, your lawyers could argue 2-CP would be out of the system in 60 minutes or 5 half lives.

Even beyond the local though, other issues are the hematomas, needle neuropraxias, etc...