I just pre-op'd a guy today who is scheduled for a very long (>4 hr) spine case. He was extremely affraid of having another anesthetic. He underwent a shoulder procedure 2 yrs ago. He received a interscalene block and a GETA. After surgery he had severe pain in the recovery room ( guess the ISB didn't work) and nausea. He was admitted for pain control and confusion. I retrieved the old chart and there is not much mention of the confusion but labs were normal. He described some hallucinations (narcotic?) and confusion as to time and place. Everything essentially resolved after 3-5 days. What are your thoughts and how would you do the case? Tomorrow, I'll tell you how I did the case.