Regional anesthesia as a 4th year medical student

[flightnurse2MD]

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Yesterday, my attending taught me how to do an adductor canal block with ultrasound for postop pain management in total knee replacements and I ended up doing five myself throughout the day while he watched. Is this common? Anyone else have similar experiences?

 

[caligas]

Yesterday, my attending taught me how to do an adductor canal block with ultrasound for postop pain management in total knee replacements and I ended up doing five myself throughout the day while he watched. Is this common? Anyone else have similar experiences?

No it’s not common but it’s great! Keep up the interest and good work and never let the bastards get you down.

 

[woopedazz]

I wish.

 

[rakotomazoto]

Definitely not common, but that is awesome.

 

[nimbus]

No reason not to. Once you learn the relevant anatomy it’s simple monkey skills. That’s great.

 

[Ronin786]

I'm a resident, but when we have a 4th year on our service we'll usually get them a random assortment of blocks over the two weeks they're there. 5 in a day is a bit abnormal only since we're still a teaching service and it's one attending and resident.

 

[abolt18]

I did a handful of blocks as a med student. Attending said "read about this, you're doing it tomorrow." Mostly axillary but a couple adductor canal blocks. A couple spinals and maybe 2 Bier blocks.

 

[The Physician Philosopher]

That's great experience!! Glad you got to experience the gig early. Regional is awesome, though I am more than a bit biased as an academic attending who does regional for a living

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[flightnurse2MD]

I'm a resident, but when we have a 4th year on our service we'll usually get them a random assortment of blocks over the two weeks they're there. 5 in a day is a bit abnormal only since we're still a teaching service and it's one attending and resident.

I lucked out and on a rotation at an outside facility with no residents, fellows, or other medical students.

 

[flightnurse2MD]

That's great experience!! Glad you got to experience the gig early. Regional is awesome, though I am more than a bit biased as an academic attending who does regional for a living

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It is pretty cool and I definitely see the validity for more postop pain management not requiring narcotics. I find it interesting that for the adductor canal blocks, they like to add 100 mcg clonidine to each 30 ml batch of 0.5% ropivicaine.

 

[flightnurse2MD]

I did a handful of blocks as a med student. Attending said "read about this, you're doing it tomorrow." Mostly axillary but a couple adductor canal blocks. A couple spinals and maybe 2 Bier blocks.

Did a spinal the other day. My first since 2010. Just like riding a bike but then again, maybe I just got lucky.

 

[The Physician Philosopher]

It is pretty cool and I definitely see the validity for more postop pain management not requiring narcotics. I find it interesting that for the adductor canal blocks, they like to add 100 mcg clonidine to each 30 ml batch of 0.5% ropivicaine.

We do 50 mcg clonidine to 20 cc of 0.25% bupi. If we want to make it last >36 hours we add 4 mg of dexamethasone to it. That's where a lot of my research is.

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[BLADEMDA]

I prefer Precedex 0.5-0.75 ug/kg with dexamethasone 4 mg to 30 mls of 0.5% Bupivacaine. IMHO, the longest duration blocks are with Bupivacaine plus adjuvants vs Ropivacaine plus adjuvants. Most of the time I simply add the dexamethasone to the Bupivacaine and call it a day (20-24 hours of reliable postop analgesia).

A comparative study of clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block

 

[The Physician Philosopher]

I prefer Precedex 0.5-0.75 ug/kg with dexamethasone 4 mg to 30 mls of 0.5% Bupivacaine. IMHO, the longest duration blocks are with Bupivacaine plus adjuvants vs Ropivacaine plus adjuvants. Most of the time I simply add the dexamethasone to the Bupivacaine and call it a day (20-24 hours of reliable postop analgesia).

A comparative study of clonidine and dexmedetomidine as an adjunct to bupivacaine in supraclavicular brachial plexus block

There was actually a systematic review on that topic that found Dex didn't prolong ropi, though it seemed to prolong bupi a good 8 hours.

Currently in the process of submitting a paper with two different doses of Dex (1 mg versus 4mg versus just bupi and epi). They last a hell of a lot longer than we anticipated. Pain came back before the block wore off completely though. Probably between 24 and 30 hours.

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[flightnurse2MD]

There was actually a systematic review on that topic that found Dex didn't prolong ropi, though it seemed to prolong bupi a good 8 hours.

Currently in the process of submitting a paper with two different doses of Dex (1 mg versus 4mg versus just bupi and epi). They last a hell of a lot longer than we anticipated. Pain came back before the block wore off completely though. Probably between 24 and 30 hours.

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Can I see a copy of that paper to show my attending???

 

[The Physician Philosopher]

Can I see a copy of that paper to show my attending???

This is one
Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis. - PubMed - NCBI


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[Ezekiel2517]

Did a spinal the other day. My first since 2010. Just like riding a bike but then again, maybe I just got lucky.

You're a 4th yr med student and you performed a spinal 8 years ago? This may not be so OK

 

[Arch Guillotti]

You're a 4th yr med student and you performed a spinal 8 years ago? This may not be so OK

Why not?

 

[flightnurse2MD]

You're a 4th yr med student and you performed a spinal 8 years ago? This may not be so OK

I was briefly in nurse anesthetist school.

 

[flightnurse2MD]

This is one
Efficacy of perineural vs systemic dexamethasone to prolong analgesia after peripheral nerve block: a systematic review and meta-analysis. - PubMed - NCBI


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Thanks!

 

[dhb]

You're a 4th yr med student and you performed a spinal 8 years ago? This may not be so OK

I did peds spinals for intra-thecal chemo when i was a med student.
Kind of surprised myself but it't like walking alone to school when i was 6...

 

[Ezekiel2517]

I did peds spinals for intra-thecal chemo when i was a med student.
Kind of surprised myself but it't like walking alone to school when i was 6...

Yah well being a med student is different than being a senior in high school (which is where most med students are 8 years before med school)

 

[Ezekiel2517]

Why not?

Well, if you or a loved one ever needs a spinal in the future, by all means let that high school student stick that needle in your back lmao

 

[Psai]

Well, if you or a loved one ever needs a spinal in the future, by all means let that high school student stick that needle in your back lmao

Is there a big difference between that and a nurse?

 

[Arch Guillotti]

Well, if you or a loved one ever needs a spinal in the future, by all means let that high school student stick that needle in your back lmao

not the case here slim

 

[flightnurse2MD]

Is there a big difference between that and a nurse?

Just ego...

 

[nimbus]

I did peds spinals for intra-thecal chemo when i was a med student.
Kind of surprised myself but it't like walking alone to school when i was 6...

When I was 7, I used to pick up my 4 year old brother at preschool on my way home from school. Times have changed.