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Regional Anesthesia in the Real World

Discussion in 'Anesthesiology' started by Mman, Mar 26, 2007.

  1. Mman

    Mman Senior Member
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    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.
     
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  3. militarymd

    militarymd SDN Angel
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    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.
     
  4. Planktonmd

    Moderator Emeritus Lifetime Donor Classifieds Approved 10+ Year Member

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    I do Interscalenes on all shoulders, Continous femorals on all total knees, axillary blocks for hands...
     
  5. Lizard1

    Lizard1 Member
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    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
     
  6. EtherMD

    EtherMD Membership Revoked
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    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.
     

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