Regional gurus: is block for liver intervention a thing?

[Hoya11]

My shop is kinda weird in that it’s very hard to get anesthesia support but a lot easier to get my pt to have a regional block. Sorry if this is a really dumb question.

I am slated to do a complex hepatobiliary procedure where I need to repeatly stimulate the liver with a 21 gauge needle, probably 10-30 times. It’s one of those cases that’s a bit borderline in IR literature, about 50/50 split between GA and IR directed moderate sedation.

I am wondering if I can get a regional block, but trying to get a sense of how difficult is it for regional anesthesia guys to block the celiac plexus or whatever regional you guys do for liver? Is it even a thing? How difficult is it? I know when I do celiac neurolysis it’s quite a production but then I also inject absolute etoh sooo.

a celiac plexus block done under fluoro is not going to make this possible..

celiac plexus blocks under fluoro are rarely 100% - have done many. not through the aorta but around it on either side.

And even with a good celiac plexus block, youve got the stimulation of getting through the somatic nociceptors of the abdominal wall.

You would have to do an epidural or a spinal - but with an epidural or spinal in place you have a CRNA monitoring the patient, you dont just pass them off to an RN with no training in that. And if you are going to have a CRNA monitor the patient, you might as well just give a propofol infusion or GA and make everyones life easier..

IMO a block is not going to help you here unfortunately

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[Arch Guillotti]

Well if you’re covering 2-4 rooms and one of them is off site, I’d consider that a problem. When you’re MD only, it doesn’t matter where the room is located.

ok point taken but a lot us direct stuff off-site on a regular basis without much of a problem.

 

[anbuitachi]

ok point taken but a lot us direct stuff off-site on a regular basis without much of a problem.

yea and a lot of crnas can do off site solo without much of a problem. its not a problem until it becomes a problem.

 

[Arch Guillotti]

I just happened to notice that it’s difficult for them to provide anesthesia down in our area but they are happy to block our patients.

Is it really the anesthesiologists though? For those of us who direct CRNA's, they are often the rate-limiting step because of their shift work. Also can be a hassle to get equipment down there. And no offense but the IR guys we work with aren't always on schedule.

 

[Arch Guillotti]

its not a problem until it becomes a problem.

Anything can become a problem at any time. Not sure what your point is. When I say off site I mean somewhere I can get to with a sprint in 1-2 minutes. Not another building.

 

[anbuitachi]

Anything can become a problem at any time. Not sure what your point is. When I say off site I mean somewhere I can get to with a sprint in 1-2 minutes. Not another building.

oh, 1-2 min is really close lol

 

[Arch Guillotti]

oh, 1-2 min is really close lol

I have some wheels when I want them.

 

[IRattending2021]

I am sorry that I didn’t make myself super clear in OP. This is a preop transhepatic biliary drain. It’s uncomfortable but in most places (5 different hospital I’ve been in) are done through moderate sedation. It’s one of those case where it’s getting a bit uncomfortable with moderate.

so I was trying to see if there is something that can take the edge off a bit rather than asking for GA when it’s unlikely I’ll be able to get it due to this thing being last minute elective. I might just do it with sedation like I usually do if our regional people say that it’s not a good option.