Regional Blocks for Periph Vasc Surgery

[VentdependenT]

Although there is no conclusive evidence that regional is better than a well planned general for these type of patients, thats not what I want to discuss.

Do you feel that the interference of the regional anesthetic with a neuro assessment outweighs their post-op pain control benefit?

---

Members don't see this ad.

 

[coprolalia]

I've done some single-leg blocks for fem-pop's, and they seem to work fine. Most importantly, patients are happy with them. The only time we don't do regional for extremity surgery is on tib plateaus and distal upper extremities where the patient needs to be monitored for compartment syndrome. Otherwise, not too sure what's particularly "risky" about them. Please explain.

-copro

 

[Planktonmd]

Do you feel that the interference of the regional anesthetic with a neuro assessment outweighs their post-op pain control benefit?

No.

 

[Mman]

I don't feel the risk outweighs the benefit. Seems to me the surgeons are most worried about checking pulses every few hours for a day or two and not quite so worried about doing a neuro exam. I mean if you're having a fem pop or whatever you probably don't have the greatest sensation in your distal extremity anyway.

 

[Dinkyconductor]

I almost never see anyone do av fistulas for dialysis under blocks, but it would seem like a good idea to me...I hate doing these under MAC (they tend to be long cases) and it seems a shame to do general for a sick old person with an incision an inch or two wide.

Maybe infraclavicular? axillary probably not the best choice, since you miss the lateral cutaneous nerve of the forearm (off the musculocutaneous) so easily

does anyone do this?

 

[lvspro]

I almost never see anyone do av fistulas for dialysis under blocks, but it would seem like a good idea to me...I hate doing these under MAC (they tend to be long cases) and it seems a shame to do general for a sick old person with an incision an inch or two wide.

Maybe infraclavicular? axillary probably not the best choice, since you miss the lateral cutaneous nerve of the forearm (off the musculocutaneous) so easily

does anyone do this?

interscalene. Where I'm at now doesn't like them, but at my DRH month (lots of regional) we used it regularly.

 

[Arch Guillotti]

I almost never see anyone do av fistulas for dialysis under blocks, but it would seem like a good idea to me...I hate doing these under MAC (they tend to be long cases) and it seems a shame to do general for a sick old person with an incision an inch or two wide.

Maybe infraclavicular? axillary probably not the best choice, since you miss the lateral cutaneous nerve of the forearm (off the musculocutaneous) so easily

does anyone do this?

We do infraclaviculars all the time for these patients.

 

[dhb]

We do spinals for all procedures on the legs even for fem-fem x.
Surg does his av fistulas under local.

 

[Mman]

I almost never see anyone do av fistulas for dialysis under blocks, but it would seem like a good idea to me...I hate doing these under MAC (they tend to be long cases) and it seems a shame to do general for a sick old person with an incision an inch or two wide.

Maybe infraclavicular? axillary probably not the best choice, since you miss the lateral cutaneous nerve of the forearm (off the musculocutaneous) so easily

does anyone do this?

One of our vascular surgeons prefers all upper extremity av fistulas to be done under block because he believes it results in better blood flow and a more successful fistula and he's in the process of setting up a research project in that area. We tend to do a lot of interscalenes and supraclavs for his patients.