Regional Anesthesia in the Real World

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

Mman

Senior Member
15+ Year Member
Joined
Mar 22, 2005
Messages
6,669
Reaction score
5,837
So, lowly resident here that gets to do lots and lots of regional blocks (stimulating caths, ultrasound, single shot, LP, sciatic, femoral, ax, infraclav, supraclav, interscalene,paravetebs, trans abdominus, etc) and is wondering what actually happens in the real world? How do you do TKAs? ankle/wrist/elbow stuff? Shoulders?

Is it mostly epidurals and PCAs? Are there actually groups that do a fair number of peripheral blocks for Ortho things?

Just curious what sort of skills will be most useful in the future.

Members don't see this ad.
 
Based a LOT on the payers....because of my payor mix, we do a lot of single shot blocks

interscalene
ax
fem
sciatic
infraclavicular


We don't do continuous catheters...or we do rarely because our payors pay pretty much the same as single shot....crazy.
 
So, lowly resident here that gets to do lots and lots of regional blocks (stimulating caths, ultrasound, single shot, LP, sciatic, femoral, ax, infraclav, supraclav, interscalene,paravetebs, trans abdominus, etc) and is wondering what actually happens in the real world? How do you do TKAs? ankle/wrist/elbow stuff? Shoulders?

Is it mostly epidurals and PCAs? Are there actually groups that do a fair number of peripheral blocks for Ortho things?

Just curious what sort of skills will be most useful in the future.
I do Interscalenes on all shoulders, Continous femorals on all total knees, axillary blocks for hands...
 
Members don't see this ad :)
lots of spinals, i mean lots for ortho cases. ton of interscalenes too - for shoulder and for fistulas

a few ankle blocks here and there and some ax blocks on occasion

single shot fem blocks were done often as well. could make a case for sciatic blocks but that extra 5 min would really po the surgeon so bypassed it
 
So, lowly resident here that gets to do lots and lots of regional blocks (stimulating caths, ultrasound, single shot, LP, sciatic, femoral, ax, infraclav, supraclav, interscalene,paravetebs, trans abdominus, etc) and is wondering what actually happens in the real world? How do you do TKAs? ankle/wrist/elbow stuff? Shoulders?

Is it mostly epidurals and PCAs? Are there actually groups that do a fair number of peripheral blocks for Ortho things?

Just curious what sort of skills will be most useful in the future.

Here is my two cents. In my busy practice you get 5 maybe ten minutes to do Regional. This means if you are proficient any and all blocks are fine. I do them all and enjoy the Regional. After a few hundred of each you should be able to do the block in 5-10 minutes. Remember, FAST plus ZERO complications is your goal. It only takes ONE major complication to result in a big lawsuit in private practice so be street wise in your decision.

I do Lumbar Plexus/Sciatic blocks for total knee replacement. This usually takes about 12-15 minutes for both. So, I discuss this with the surgeon and most are okay with the extra few minutes over a spinal. A few just want the spinal plus Femoral block in Pacu. I have been doing that simple technique since the early 1990's and can tell you after about three thousand of them that patients are satisfied with that technique.
 
Top