surgeons stealing our TAPs!

[GaseousClay]

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not that I care because I don't bill, but most of our generalists and now gyn surgeons are doing their own TAP blocks. anyone else noticing this trend?

 

[BLADEMDA]

not that I care because I don't bill, but most of our generalists and now gyn surgeons are doing their own TAP blocks. anyone else noticing this trend?

Yes. They are "inferior" blocks IMHO but better than no block at all. We need a double blinded study looking at their tap blocks vs 4 quadrant tap blocks performed by us.
Or, as my partners would say "I'm glad to be doing less work" so let them do the TAP blocks.


https://www.hpbonline.org/article/S1365-182X(17)30129-6/fulltext

https://academic.oup.com/asj/article/35/1/72/224765

 

[IMGASMD]

According to our on-q rep, some of them are putting in their own catheters..... hmmmm

 

[Psai]

I think it was started by a surgeon although it's a vascular vs IR kind of argument. I see the surgeons doing it without ultrasound very occasionally and there's really no point to that. Might as well just put in some local at the incision site and call it a day. Either way I think the tap block is greatly inferior to paravertebral block or thoracic epidural.

Our gyns don't do them at all but then again they can barely get their part down so yeah

 

[drmwvr]

Yes. They are "inferior" blocks IMHO but better than no block at all. We need a double blinded study looking at their tap blocks vs 4 quadrant tap blocks performed by us.
Or, as my partners would say "I'm glad to be doing less work" so let them do the TAP blocks.

They have the abdominal wall exposed. Why wouldn't a thoughtful surgeon take advantage of that? I have "partners" that are of the same sour grapes world view, but their orientation is less patient well being than their own well being.

 

[ZzzPlz]

I’m seeing this too—some surgeons insist on doing their own “TAP” block

My understanding is that they can’t bill a dime for doing their own blocks, but we can obviously get a little more $$ for performing them. And ours definitely work better. What gives?

 

[drmwvr]

I’m seeing this too—some surgeons insist on doing their own “TAP” block

My understanding is that they can’t bill a dime for doing their own blocks, but we can obviously get a little more $$ for performing them. And ours definitely work better. What gives?

Definitely? Whether that is true or not, ours "slow them down."

 

[ZzzPlz]

yes definitely. The surgeons I see doing these “TAPS” are basically making a wheal just superficial to the fascia. They’d be much better off just injecting local around the incisions.

Yes, if you insist on making the OR wait while you TAP before prep or turnover that slows things down. But I have no problem doing TAPs in PACU if the surgeon is NFA

 

[Tony C anesthesia]

not that I care because I don't bill, but most of our generalists and now gyn surgeons are doing their own TAP blocks. anyone else noticing this trend?

Nobody cares about this! Let them do it.

 

[Psai]

They have the abdominal wall exposed. Why wouldn't a thoughtful surgeon take advantage of that? I have "partners" that are of the same sour grapes world view, but their orientation is less patient well being than their own well being.

All they can do is make sure the local doesnt go in the peritoneum. If you don't go between the correct layers, there is really no point. It would be akin to dumping local in the subq instead of the epidural space.

I don't understand the slow them down argument. It takes me less than 5 minutes to do the block.

 

[coffeebythelake]

I don't understand the slow them down argument. It takes me less than 5 minutes to do the block.

What can I say? Some surgeons live in their own deluded world. The same surgeons complain when u put in a second IV before tucking arms in a potentially bloody surgery because it wastes time

 

[GaseousClay]

What can I say? Some surgeons live in their own deluded world. The same surgeons complain when u put in a second IV before tucking arms in a potentially bloody surgery because it wastes time

thats why im happy im not in private practice you truly are the surgeon's B

 

[Mman]

thats why im happy im not in private practice you truly are the surgeon's B

I'm happy to be in private practice with good, fast surgeons instead of in academics watching the intern learn how to tie knots at 3 AM.

 

[coffeebythelake]

thats why im happy im not in private practice you truly are the surgeon's B

Isn't there more collegiality between surgeon and anesthesiologist in PP?? I mean you probably worj with the same people mpre frequently. In academics, there are a lot of dingus surgeons.

 

[Twiggidy]

i generally want to do as little to patients as possible

 

[GaseousClay]

I'm happy to be in private practice with good, fast surgeons instead of in academics watching the intern learn how to tie knots at 3 AM.

Academic attendings will def not be sitting in a room at 3am

 

[GaseousClay]

Isn't there more collegiality between surgeon and anesthesiologist in PP?? I mean you probably worj with the same people mpre frequently. In academics, there are a lot of dingus surgeons.

i guess it depends there are dinguses on both sides. in the non private world at least, you are paid regardless of what the surgeon tells you you can or can not do. Also a lot more room to tell them to wait patiently to put in more lines or do blocks if necessary for the patient. To each their own tho both have pluses and minuses

 

[Twiggidy]

Academic attendings will def not be sitting in a room at 3am

This is a reason I sometimes wish I were in academics, especially in regards to Obstetric anesthesia

 

[dhb]

I would never trust a surgeon for a block.

 

[woopedazz]

not that I care because I don't bill, but most of our generalists and now gyn surgeons are doing their own TAP blocks. anyone else noticing this trend?

Who knew you could TAP block a ureter?

 

[deleted162650]

Who knew you could TAP block a ureter?

That way it’s less painful when you cut it.

 

[acidbase1]

Mine does them under laparoscopic guidance, main problem is he does them between the transversus abdominis and perioneum

 

[Psai]

Mine does them under laparoscopic guidance, main problem is he does them between the transversus abdominis and perioneum

You can't do a tap block with laparoscopic guidance

 

[Consigliere]

i generally want to do as little to patients as possible

Now this....THIS is the voice of experiece. All you young guns can put it your ultrasound guided, super duper catheters. Not I.

 

[narcotics999]

Mine does them under laparoscopic guidance, main problem is he does them between the transversus abdominis and perioneum

TAP = transversus abdominis perioneum!

 

[Twiggidy]

Now this....THIS is the voice of experiece. All you young guns can put it your ultrasound guided, super duper catheters. Not I.

Seriously. The more desire to poke and prod patients the more you set yourself up for complaints and complications.

 

[dhb]

Seriously. The more desire to poke and prod patients the more you set yourself up for complaints and complications.

Send them to cards for TAP clearance 😉

 

[Psai]

Send them to cards for TAP clearance 😉

"Not cleared for tap, consider thoracic epidural or LMA instead".

 

[Twiggidy]

Send them to cards for TAP clearance 😉

i mean, reallly, why didnt i do Rads and 3 fellowships and call it a life? 😎

 

[acidbase1]

You can't do a tap block with laparoscopic guidance

My point exactly

 

[Noyac]

Yes. They are "inferior" blocks IMHO but better than no block at all. We need a double blinded study looking at their tap blocks vs 4 quadrant tap blocks performed by us./QUOTE]y

They will look like our surgeon placed local Exparel for joints. Piss poor.