Timing of PT post nerve block

[seinfeld]

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Our PT dept wont let patient ambulate when they have the slightest bit of SENSORY block. What are the standards at your hospitals?

 

[Intrathecal]

Our total knee patients start getting oob and ambulate with assist with PT on POD#1. I do get complaints about knee buckling with the fem cath, and I use 0.125% bupiv 6-8cc/hr. They usually just deal with it, since the benefits of the fem cath outweigh the problems. Without the fem cath patients just narc themselves with the PCA to the point that they can't work with PT, or they don't use the PCA at all which causes too much pain for PT.

They used to even bolus the catheter with 20cc of local before PT works with them, but I did away with that and noticed the therapists complained less about the buckling.

 

[USAnesthesiaDoc]

Depends on what our surgeons want. One guy has PT get patients out of bed same day of surgery, but this usually consists of just standing and not ambulating much. Others do it POD #1. Occasionally get complaints of buckling, but then we either decrease the continuous rate or decrease the ropivacaine concentration. I was putting everyone on a rate of 5 ml/hr of 0.2% ropivacaine but have decrease to 0.1% just recently to see if we can decrease buckling even more.

 

[pmichaelmd]

We have been using 0.2% ropivacaine at 8cc/hr with a pt. demand dose of 4cc q30 min without many complaints of buckling and they get OOB the evening of surgery. We are toying with decreasing the concentration to 0.15% rop, but we'll see.

PMMD

 

[SleepIsGood]

We have been using 0.2% ropivacaine at 8cc/hr with a pt. demand dose of 4cc q30 min without many complaints of buckling and they get OOB the evening of surgery. We are toying with decreasing the concentration to 0.15% rop, but we'll see.

PMMD

Are youguys just putting in fem nerve caths? Recently we've been doing a single shot sciatic as well (to decrease the back of hte knee pain).

I have heard something about PT not liking this. However, patients are pain free. To me, it seems optimal to block both of these nerves. Wht do you all do/think?

 

[USAnesthesiaDoc]

We do femoral catheters for all of our total knees, and only one of our orthopods wants us to do single shot sciatics. When I say that, I mean that he knows that we do them for patient comfort but doesn't particularly ask for them. However, he really doesn't want any foot drop at all from the sciatics, so I'm only using 30 mL of 0.2% ropivacaine for the sciatic. This doesn't last very long and so maybe isn't worth doing but the patients are very happy until the block wears off.

As far as what PT wants, it doesn't really play into the situation. We go along with what the surgeon requests and then PT just deals with it.

I personally think adding the sciatic makes it much nicer for the patients, but the orthopods are very wary of sciatic nerve injury and are just plain uncomfortable until any foot drop or even just decreased sensation/numbness from a block is completely resolved.