Thoracic epidurals

[OldManDave]

I hear this all the time from residents, "don't let the evidence confuse me, based on my experience, I know what to do."

That is not what that phrase implies. As someone with a mere 19 or so months of experience, I am not so brash as to proffer the assertion you have made. My statement applies to medicine, including clinical medicine, as a whole. Face it - much of what is taught in med school is still based upon prokaryotes & eukaryotes - not on organ systems as complex as a hominid.

Please take a moment to actually read my post before you decide to make slighting comments based upon it.

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[militarymd]

No one will argue that thoracic epidurals will give you superior pain relief. You don't need a study to know it. A simple observer can see it.

Good pain relief alone can be the only indication needed to give someone a thoracic epidural.

I start having problems when you start telling people that this neuroaxial technique can do things that it cannot do....based on evidence.

Based on at least 2 studies that I know of....atelectasis...as graded by a chest CT, there is no improvement in the group of patients with the neuroaxial block and who have better pain control.

 

[militarymd]

Please take a moment to actually read my post before you decide to make slighting comments based upon it.

What's slighting about what I said?

I'm simply point out that MANY clinicans out there don't like having evidence complicate their practice....which doesn't change....I have met WAY too many anesthesiologists who, the second after they finish, residency...and many who at the CA2 level has decided that they know it all.

The practice of medicine continuously changes.......based on new evidence that comes out every day/week/month.

If you wait until there is irrefutable proof before you abandon old practices, then you will always be a day late and a dollar short.

As I've said, if you're putting epidurals in for pain relief then fine, but if you're putting them in thinking that you are preventing atelectasis, then I think you are passing bad information to someone.

 

[jetproppilot]

What's slighting about what I said?

I'm simply point out that MANY clinicans out there don't like having evidence complicate their practice....which doesn't change....I have met WAY too many anesthesiologists who, the second after they finish, residency...and many who at the CA2 level has decided that they know it all.

The practice of medicine continuously changes.......based on new evidence that comes out every day/week/month.

If you wait until there is irrefutable proof before you abandon old practices, then you will always be a day late and a dollar short.

As I've said, if you're putting epidurals in for pain relief then fine, but if you're putting them in thinking that you are preventing atelectasis, then I think you are passing bad information to someone.

cant argue with that.

 

[OldManDave]

MilMD,

Maybe it was me that misinterpreted the meaning of your statement. I, apparently erroneously, thought you were implying that as a CA-2 resident that I did not use evidence & based decisions on my immense (sarcasm intended) experential base. Now, after practicing what I was preaching - read your post from a different perspective & completely agree with your point & the point you made above.

My apologies - I was the one who was in error.

 

[militarymd]

MilMD,

Maybe it was me that misinterpreted the meaning of your statement. I, apparently erroneously, thought you were implying that as a CA-2 resident that I did not use evidence & based decisions on my immense (sarcasm intended) experential base. Now, after practicing what I was preaching - read your post from a different perspective & completely agree with your point & the point you made above.

My apologies - I was the one who was in error.