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A year or so ago, I was shadowing a resident in a surgicenter-type shop with lots of quick surgeries and regional, etc.
The resident was giving a nerve block to an older Navy vet who was going in for rotator cuff surgery. I forget the block name (my bad), but I'm sure a lot of you vets (of the anesthesiology variety, not necessarily the military kind) already know what it was.
At any rate, the resident gave a shot of lidocaine and proceeded with the block about 3 minutes later when the attending rolled in. The block was US-guided and about half way to the destination, I noticed the vet was in quite a bit of pain. Every time the needle inched a bit deeper, he would grimace pretty badly. He was starting to sweat and his breathing was getting pretty quick. The resident and the attending didn't notice as they were both pretty fixated on the monitor. Neither I nor the vet said anything and the block was placed maybe 2 minutes later.
So, my question is, how should the compassionate anesthesiologist respond to this situation? It seems like a horrible idea to pull the needle out, re-apply lidocaine and try again. It also seems like a terrible idea to try to leave the needle in mid-block and inject more lido with a separate needle. Did they do the right thing by just getting it over and done with? Is the take-home lesson just to be generous with the lidocaine in the first place?
The resident was giving a nerve block to an older Navy vet who was going in for rotator cuff surgery. I forget the block name (my bad), but I'm sure a lot of you vets (of the anesthesiology variety, not necessarily the military kind) already know what it was.
At any rate, the resident gave a shot of lidocaine and proceeded with the block about 3 minutes later when the attending rolled in. The block was US-guided and about half way to the destination, I noticed the vet was in quite a bit of pain. Every time the needle inched a bit deeper, he would grimace pretty badly. He was starting to sweat and his breathing was getting pretty quick. The resident and the attending didn't notice as they were both pretty fixated on the monitor. Neither I nor the vet said anything and the block was placed maybe 2 minutes later.
So, my question is, how should the compassionate anesthesiologist respond to this situation? It seems like a horrible idea to pull the needle out, re-apply lidocaine and try again. It also seems like a terrible idea to try to leave the needle in mid-block and inject more lido with a separate needle. Did they do the right thing by just getting it over and done with? Is the take-home lesson just to be generous with the lidocaine in the first place?