Post op block checks

[anbuitachi]

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Im in academic institution. Just curious what PP do or other institutions. This is a big deal at our institution. Currently we must call the next day for patients whos received blocks preferably in business hour so they can see someone if there are issues. Catheter gets phone calls DAILY until catheter is removed.

What are some complications people have seen? Do you all call patients within 24 hours? (I prefer to do within 48 hrs since some people still have numbness at 24) never had an issue in my years, only have people complain to me about other stuff that should be directed to the surgeon so these calls often takes way longer than i expect especially with many patients.

I also ask because they usually stay in the hospital for 1-2 hours post procedure in PACU, or recovery area before leaving the hospital, so often times this is a few hours after the block. You'd think most of the serious complications wouldve happened already. The only thing i could think of is numbness, weakness, infection, that may warrant further care. even then i'd go tell them to follow up with a neurologist. does anyone tell them to come in and see an anesthesiologist?

permanent dmg / numbness do happen obviously , how often do you wait before eg a bupivicaine block, before telling them to go see a neurologist? if they still have numbness 48 hours later do you tell them to see a neurologist? Are there even any treatments..? How do you even tell its the block and not the surgery (if same distribution)?

 

[ZzzPlz]

Im in academic institution. Just curious what PP do or other institutions. This is a big deal at our institution. Currently we must call the next day for patients whos received blocks preferably in business hour so they can see someone if there are issues. Catheter gets phone calls DAILY until catheter is removed.

What are some complications people have seen? Do you all call patients within 24 hours? (I prefer to do within 48 hrs since some people still have numbness at 24) never had an issue in my years, only have people complain to me about other stuff that should be directed to the surgeon so these calls often takes way longer than i expect especially with many patients.

I also ask because they usually stay in the hospital for 1-2 hours post procedure in PACU, or recovery area before leaving the hospital, so often times this is a few hours after the block. You'd think most of the serious complications wouldve happened already. The only thing i could think of is numbness, weakness, infection, that may warrant further care. even then i'd go tell them to follow up with a neurologist. does anyone tell them to come in and see an anesthesiologist?

permanent dmg / numbness do happen obviously , how often do you wait before eg a bupivicaine block, before telling them to go see a neurologist? if they still have numbness 48 hours later do you tell them to see a neurologist? Are there even any treatments..? How do you even tell its the block and not the surgery (if same distribution)?

I tell people to wait 6 weeks before consulting a neurologist. I believe this is the board answer as well. I’ve only seen this once so far (wasn’t my block of course 😀)

 

[GlowInTheDark]

We round on any inpatients, mostly just for the experience of seeing your patient and how the block did.

...And having to face the ones you know it didn’t work on.

 

[rakotomazoto]

We only follow up with patients who have an epidural running. Anything single-shot (spinal, PNB's) are free to call if there are any questions or concerns.

 

[kmurp]

We see inpatients with catheters and call daily if discharged while catheter is in (usually ....).

 

[anbuitachi]

Any complications from these blocks (not epidurals) anyone's seen that's had to be addressed within 48 hours?

 

[MirrorTodd]

Any complications from these blocks (not epidurals) anyone's seen that's had to be addressed within 48 hours?

Most we've had has been a problem with the alligator clip at the end of the catheter unclipping on its own. Manufacturer already working on a fix supposedly. This might make a good QI project for our institution actually.

 

[GaseousClay]

Mostly do single shot PNB so no follow up. Our surgeons ask them about the block during post-op visit and they relay anything back to us.

 

[deleted697535]

Phone all catheters until removed. Phone all single shots on day 1 only. Massive pain in the a$$. Yields absolutely 0 useful info but can be billed per call. And residents do 99% of it so free money basically

 

[deleted162650]

Phone all catheters until removed. Phone all single shots on day 1 only. Massive pain in the a$$. Yields absolutely 0 useful info but can be billed per call. And residents do 99% of it so free money basically

Cannot bill for the single shot f/u in the US. Only catheter follow-up.

 

[okayplayer]

Phone all catheters until removed. Phone all single shots on day 1 only. Massive pain in the a$$. Yields absolutely 0 useful info but can be billed per call. And residents do 99% of it so free money basically

I’m pretty sure you can’t bill for follow up on even a catheter if it is over the phone.

 

[deleted697535]

You're fvcking with me right? I dont work in the states so idk. But why the hell do you all do blocks if you cant bill for them when there is very little good evidence theyre any better than a ga.

The only thing id consider a block for is an isb catheter for shoulder replacement in a frail patient.

Everyone else should get a spinal or ga. Single shot blocks actually are more harmful than good and should be banned. They just kick the can 16 hours down the road so its someone elses problem. Exparel might change my mind in 10 years time

 

[deleted162650]

You're fvcking with me right? I dont work in the states so idk. But why the hell do you all do blocks if you cant bill for them when there is very little good evidence theyre any better than a ga.

The only thing id consider a block for is an isb catheter for shoulder replacement in a frail patient.

Everyone else should get a spinal or ga. Single shot blocks actually are more harmful than good and should be banned. They just kick the can 16 hours down the road so its someone elses problem. Exparel might change my mind in 10 years time

We bill for blocks for post-op pain in addition to the fee for the primary anesthetic. If the block is your primary anesthetic you cannot bill for it separately.

Your single shot block comment is complete horse manure.

 

[anbuitachi]

You're fvcking with me right? I dont work in the states so idk. But why the hell do you all do blocks if you cant bill for them when there is very little good evidence theyre any better than a ga.

The only thing id consider a block for is an isb catheter for shoulder replacement in a frail patient.

Everyone else should get a spinal or ga. Single shot blocks actually are more harmful than good and should be banned. They just kick the can 16 hours down the road so its someone elses problem. Exparel might change my mind in 10 years time

why are they more harmful? it provides the patient good amount of comfort hours after the procedure

 

[fakin' the funk]

We have a robust regional service (lots of catheters) and complicated follow up, but it boils down to inpatients with PNB catheters get daily follow-up until discharge, outpatients with catheters get 1 phonecall on pod#1.

The phone calls are damn near useless, often you just listen to the patient beg for a catheter refill at 3days postop
-

 

[dhb]

You're fvcking with me right? I dont work in the states so idk. But why the hell do you all do blocks if you cant bill for them when there is very little good evidence theyre any better than a ga.

The only thing id consider a block for is an isb catheter for shoulder replacement in a frail patient.

Everyone else should get a spinal or ga. Single shot blocks actually are more harmful than good and should be banned. They just kick the can 16 hours down the road so its someone elses problem. Exparel might change my mind in 10 years time

You make 0 sense i don't know where and how you practice but from your posts it appears you are a couple of standard deviations from what most people experience is.

 

[Arch Guillotti]

You're fvcking with me right? I dont work in the states so idk. But why the hell do you all do blocks if you cant bill for them when there is very little good evidence theyre any better than a ga.

The only thing id consider a block for is an isb catheter for shoulder replacement in a frail patient.

Everyone else should get a spinal or ga. Single shot blocks actually are more harmful than good and should be banned. They just kick the can 16 hours down the road so its someone elses problem. Exparel might change my mind in 10 years time

This is nonsense!😕

 

[Southpaw]

Everyone else should get a spinal or ga. Single shot blocks actually are more harmful than good and should be banned. They just kick the can 16 hours down the road so its someone elses problem. Exparel might change my mind in 10 years time

I believe you're still in training? Think for a few min about why you'd advocate for a spinal but not a SSB.

 

[AdmiralChz]

Everyone else should get a spinal or ga. Single shot blocks actually are more harmful than good and should be banned. They just kick the can 16 hours down the road so its someone elses problem. Exparel might change my mind in 10 years time

Good luck working with any orthopedic surgeons in your career with this approach.

Have you reviewed any of the literature out there in the last 5 years? Most of the early enthusiasm with Exparel has not panned out.

 

[IMGASMD]

Good luck working with any orthopedic surgeons in your career with this approach.

Have you reviewed any of the literature out there in the last 5 years? Most of the early enthusiasm with Exparel has not panned out.

My now partners swears by them. We almost exclusive single show exparel at this time.

I trained with On-Q for three days, for knees. Follow up daily in house, remove before discharge. Before my time they use to send them home with catheter, but then didn’t want to deal with complications and removal so nixed the program. Didn’t use much exparel in training. A lot of field blocks by the surgeons with exparel then the pain attendings wouldn’t put the catheter in. It was a big to do every time the surgeons just block “something.”

 

[jwk]

Good luck working with any orthopedic surgeons in your career with this approach.

Have you reviewed any of the literature out there in the last 5 years? Most of the early enthusiasm with Exparel has not panned out.

I've had both shoulders scoped. First one three years ago with ISB and catheter, pulled at 3 days. Phrenic involvement resolved after adjusting infusion downward 10hrs postop. Last scope was three months ago with Exparel. The motor block + phrenic not fully resolved till about 30 hrs, and sensory block lasted 3-1/2 days. Didn't like that there was no way for the phrenic involvement to improve except wait it out, but really impressed with the prolonged pain relief without the catheter.

 

[AdmiralChz]

Can’t speak for everyone, but we recently stopped using it altogether. We didn’t see much improvement/Block duration over Ropiv/Clonidine with decadron. Order of magnitude cheaper. Just our experience.

 

[deleted697535]

Ouch that got real personal real quick. Im out

 

[anbuitachi]

Can’t speak for everyone, but we recently stopped using it altogether. We didn’t see much improvement/Block duration over Ropiv/Clonidine with decadron. Order of magnitude cheaper. Just our experience.

i dont think there is any benefit in terms of duration with local + decadron. there are some studies being done though to better clarify

 

[dhb]

Ouch that got real personal real quick. Im out

Nothing personal 😉, if you want to learn a thing or 2 just ask a couple of questions...

 

[dhb]

I've had surgeries without blocks and the patients i have for the same surgeries are much more comfortable with a regional technique.

Decadron not only prolongs the duration but also smooths out the wake up you don't have the on/off effect you can have with strait local

I've not placed a nerve cath in a very long time: i just don't see the indication anymore.

 

[deleted697535]

Nothing personal 😉, if you want to learn a thing or 2 just ask a couple of questions...

Lol

 

[Ronin786]

I've had both shoulders scoped. First one three years ago with ISB and catheter, pulled at 3 days. Phrenic involvement resolved after adjusting infusion downward 10hrs postop. Last scope was three months ago with Exparel. The motor block + phrenic not fully resolved till about 30 hrs, and sensory block lasted 3-1/2 days. Didn't like that there was no way for the phrenic involvement to improve except wait it out, but really impressed with the prolonged pain relief without the catheter.

I read the data behind Exparel and it really is not impressive at all and carries an incredible industry bias. But then I read multiple anecdotes like this and wonder what the **** is going on in those liposomes.

 

[dhb]

Lol

Keep up the good GA/spinal chief.