Too good to be true?

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mmag

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Got this in my inbox today. There has to be a catch right?
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Members don't see this ad :)
sevo00 said:
I



It says 1 mil over first two years. So basically 500k a year lol. What a dumb way to advertise pay. Like saying sign up for this job you’ll make 10 mil over 20 years
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It’s a hard place to recruit. The panhandle. Outside of 30A corridor, things get desolute.

Heck. Regular ortho centers can’t get docs to even work 4 days a week (4) 10s with 10 weeks off for 500k 5 min from Atlantic Ocean

Surgery center work is not as desirable as people think. By that I mean. It’s hard to find a regular anesthesiologist to work there daily. You will get a patch work of 1099 docs who fill in as needed

People want to work when they want to work. They don’t want to be dictated to have to work 5 days a week. It’s sounds strange to a lot of you guys what I’ve been posting the last couple of years.

But this is the trend I have noticed. Because the vast majority of these docs who go to surgery center jobs are on the retirement track.

The heavy hitters who want the money also want the hours to bill continuously. And a surgery center simply can’t offer that. So they are in no man’s land with being able to recruit a regular full time MD unless it’s 100% supervision plus early days plus 4 days a week. I gotta cover a surgery center like that for a 66 year old anesthesia doc a few days coming up. That’s the type of surgery center these retirement track docs want. 4 days. Early days plus 100% supervision plus no blocks , like gi, podiatry, gyn, cysto/lma and eyes. And low volume

No one wants to do 8-10 blocks a day at surgery center anymore. Too much work.
 
aneftp said:
It’s a hard place to recruit. The panhandle. Outside of 30A corridor, things get desolute.

Heck. Regular ortho centers can’t get docs to even work 4 days a week (4) 10s with 10 weeks off for 500k 5 min from Atlantic Ocean

Surgery center work is not as desirable as people think. By that I mean. It’s hard to find a regular anesthesiologist to work there daily. You will get a patch work of 1099 docs who fill in as needed

People want to work when they want to work. They don’t want to be dictated to have to work 5 days a week. It’s sounds strange to a lot of you guys what I’ve been posting the last couple of years.

But this is the trend I have noticed. Because the vast majority of these docs who go to surgery center jobs are on the retirement track.

The heavy hitters who want the money also want the hours to bill continuously. And a surgery center simply can’t offer that. So they are in no man’s land with being able to recruit a regular full time MD unless it’s 100% supervision plus early days plus 4 days a week. I gotta cover a surgery center like that for a 66 year old anesthesia doc a few days coming up. That’s the type of surgery center these retirement track docs want. 4 days. Early days plus 100% supervision plus no blocks , like gi, podiatry, gyn, cysto/lma and eyes. And low volume

No one wants to do 8-10 blocks a day at surgery center anymore. Too much work.
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It’s hard to recruit because they don’t want to increase the pay. 500k is nothing special nowadays. If this was 700k a year I’m sure they would have no problems recruiting. They make plenty from facility fees, I’m sure the surgeon owners make well over 7 figures
 
sevo00 said:
It’s hard to recruit because they don’t want to increase the pay. 500k is nothing special nowadays. If this was 700k a year I’m sure they would have no problems recruiting. They make plenty from facility fees, I’m sure the surgeon owners make well over 7 figures
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It’s everything. Location, pay, time off, work load

I’d gladly take 450k /8 weeks off/4 days a week (off by 12-2pm daily or earlier at the surgery center anymore I’m covering next month. This 66 yo dude says he’s gonna to ride it till the wheels falls off. It’s that easy.

I know a couple of the crnas there anyways (because I just know a lot of people). They tell me just to show up and do nothing besides sign some charts. I would have done it for $300/hr and they are giving me $350/hr with 8 hr guarantee.

Everything factors into my decision when I work.

The other ortho center does pay 700k/8 weeks off. Sounds great till you realize you are gonna to work 55-60 hours a week/ all 5 days a week (Tuesdays are bad to 7-8pm) be lucky to get out by 5pm any day. Who wants that job? No one.
 
sevo00 said:
I



It says 1 mil over first two years. So basically 500k a year lol. What a dumb way to advertise pay. Like saying sign up for this job you’ll make 10 mil over 20 years
Click to expand...

Well maybe it means 300k for the first year and 700k for the second year. And they work really hard to make u quit by year 1
 
aneftp said:
It’s a hard place to recruit. The panhandle. Outside of 30A corridor, things get desolute.

Heck. Regular ortho centers can’t get docs to even work 4 days a week (4) 10s with 10 weeks off for 500k 5 min from Atlantic Ocean

Surgery center work is not as desirable as people think. By that I mean. It’s hard to find a regular anesthesiologist to work there daily. You will get a patch work of 1099 docs who fill in as needed

People want to work when they want to work. They don’t want to be dictated to have to work 5 days a week. It’s sounds strange to a lot of you guys what I’ve been posting the last couple of years.

But this is the trend I have noticed. Because the vast majority of these docs who go to surgery center jobs are on the retirement track.

The heavy hitters who want the money also want the hours to bill continuously. And a surgery center simply can’t offer that. So they are in no man’s land with being able to recruit a regular full time MD unless it’s 100% supervision plus early days plus 4 days a week. I gotta cover a surgery center like that for a 66 year old anesthesia doc a few days coming up. That’s the type of surgery center these retirement track docs want. 4 days. Early days plus 100% supervision plus no blocks , like gi, podiatry, gyn, cysto/lma and eyes. And low volume

No one wants to do 8-10 blocks a day at surgery center anymore. Too much work.
Click to expand...

I’m not wasting my time rushing to do blocks all day, plus the case.
 
Members don't see this ad :)
coffeebythelake said:
Exactly plenty of good paying places that are more cush and less stress than running around doing blocks all day long. That demands a big premium in my mjnd
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I turned down $9000. That’s $9000 to cover an orthopedic center in November on a Friday for 13 hours. That’s massive money. They had to shut down after 5pm instead of going to 8pm because 2 anesthesia doctors I hooked up split it and both had to be at other places. So one doc covered 630am-1130am (he had to take call at my old hospital). And my current homeboy was working post call and driving up to the surgery center to take over at 1130-am to 5pm but his girlfriend demanded him home by 6pm.

So even a big premium won’t get me to work. And that’s the place that pays the full time anesthesia doctor $700k with 8 weeks off. No calls. No weekends. Sounds good on paper….buyer beware.
 
aneftp said:
I turned down $9000. That’s $9000 to cover an orthopedic center in November on a Friday for 13 hours. That’s massive money. They had to shut down after 5pm instead of going to 8pm because 2 anesthesia doctors I hooked up split it and both had to be at other places. So one doc covered 630am-1130am (he had to take call at my old hospital). And my current homeboy was working post call and driving up to the surgery center to take over at 1130-am to 5pm but his girlfriend demanded him home by 6pm.

So even a big premium won’t get me to work. And that’s the place that pays the full time anesthesia doctor $700k with 8 weeks off. No calls. No weekends. Sounds good on paper….buyer beware.
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Caveat emptor indeed.
 
Last figures I saw for “ASA Closed Claims”, had (other than death) nerve block injuries as the most likely reason to get sued.

The increasing push to “do a block” for any/everything over the last 5-10 years, doesn’t fit into a risk/benefit profile that’s to my liking (“Hey! How would you like to risk lifelong limb paralysis, for 1-2 days of improved pain relief???!!!!).

I know some of you guys will tell me you’ve never seen or had a single complication with your nerve blocks. Congrats…..I’ve managed to dodge that bullet (so far). I’ve had partners get some scary phone calls.

Maybe I’m just an old “fuddy-duddy”, but dealing with a bunch of primadonna ortho surgeons, and doing 10-15 blocks a DAY (increasing the possiblility of lawsuit exposure, vs. my usual of 10-15 a MONTH) doesn’t appeal to me.
 
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DirtDocMD said:
Last figures I saw for “ASA Closed Claims”, had (other than death) nerve block injuries as the most likely reason to get sued.

The increasing push to “do a block” for any/everything over the last 5-10 years, doesn’t fit into a risk/benefit profile that’s to my liking (“Hey! How would you like to risk lifelong limb paralysis, for 1-2 days of improved pain relief???!!!!).

I know some of you guys will tell me you’ve never seen or had a single complication with your nerve blocks. Congrats…..I’ve managed to dodge that bullet (so far). I’ve had partners get some scary phone calls.

Maybe I’m just an old “fuddy-duddy”, but dealing with a bunch of primadonna ortho surgeons, and doing 10-15 blocks a DAY (increasing the possiblility of lawsuit exposure, vs. my usual of 10-15 a MONTH) doesn’t appeal to me.
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Where’d you see these figures? I’d like to look at them and discuss here. Everyone should know where their greatest risks are in modern practice
 
PainInTheAnes said:
Where’d you see these figures? I’d like to look at them and discuss here. Everyone should know where their greatest risks are in modern practice
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The most common complications were death (26%), nerve injury (22%) and permanent brain damage (9%).

pubmed.ncbi.nlm.nih.gov

Closed claims' analysis - PubMed

The American Society of Anesthesiologists (ASA) Closed Claims database was started in 1985 to study anaesthesia injuries to improve patient safety, now containing 8954 claims with 5230 claims since 1990. Over the decades, claims for surgical anaesthesia decreased, while claims for acute and...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Anyways obesity is the most significant factor in ANY CLOSED CLAIMS cases. The doctors company (a major malpractice company) I used to carry malpractice with even published their own study saying obesity is the factor in 50% of all their closer claims payouts

Obviously the most common claim payout is tooth damage.

www.thedoctors.com

Anesthesiology Closed Claims Study

The Doctors Company studied 640 anesthesia medical malpractice claims that closed from 2007–2012 and 587 claims that closed between 2013–2018. These studies determined whether the number of patient injuries had decreased and to identify any new trends in claims involving anesthesia care.
www.thedoctors.com www.thedoctors.com
 
NicholasPavona said:
My greatest risk.....which far exceeds all others....is hurting my hand after delivering a devastating right hook to wipe the smarmy look off a CRNA's face.
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I actually laughed out loud at this as I was so taken off guard when I read it. Not promoting violence. Just the shock factor of this comment was hilarious to me.
 
DirtDocMD said:
Last figures I saw for “ASA Closed Claims”, had (other than death) nerve block injuries as the most likely reason to get sued.

The increasing push to “do a block” for any/everything over the last 5-10 years, doesn’t fit into a risk/benefit profile that’s to my liking (“Hey! How would you like to risk lifelong limb paralysis, for 1-2 days of improved pain relief???!!!!).

I know some of you guys will tell me you’ve never seen or had a single complication with your nerve blocks. Congrats…..I’ve managed to dodge that bullet (so far). I’ve had partners get some scary phone calls.

Maybe I’m just an old “fuddy-duddy”, but dealing with a bunch of primadonna ortho surgeons, and doing 10-15 blocks a DAY (increasing the possiblility of lawsuit exposure, vs. my usual of 10-15 a MONTH) doesn’t appeal to me.
Click to expand...
Most peers I have worked with who do not "like" blocks appear simply too lazy to become proficient, not because they are actually worried about a bad outcome. Hard to believe this is still a discussion in 2025. No one likes the orthos with attitudes, but I am not doing blocks for their benefit. Nothing personal towards your statement, and respect it, just my experience.
 
Harpoon1 said:
Most peers I have worked with who do not "like" blocks appear simply too lazy to become proficient, not because they are actually worried about a bad outcome. Hard to believe this is still a discussion in 2025. No one likes the orthos with attitudes, but I am not doing blocks for their benefit. Nothing personal towards your statement, and respect it, just my experience.
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For those getting back to doing blocks, such as myself after years of academia, it is hard to develop proficiency when ortho breathing down your neck and being little bitches about being too slow.
 
coffeebythelake said:
For those getting back to doing blocks, such as myself after years of academia, it is hard to develop proficiency when ortho breathing down your neck and being little bitches about being too slow.
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yeah. Best to work in tandem with another anesthesia doc at hospital to get urself up to speed.

I work with an older doc who’s isn’t good with blocks. Been working with him to get his confidence up. He loves doing labor epidurals. And I hate doing labor epidurals. So it’s a good tag team we have going.

But after first case starts. We have more downtime for the older doc to work on his regional blocks.
 
Harpoon1 said:
Most peers I have worked with who do not "like" blocks appear simply too lazy to become proficient, not because they are actually worried about a bad outcome. Hard to believe this is still a discussion in 2025. No one likes the orthos with attitudes, but I am not doing blocks for their benefit. Nothing personal towards your statement, and respect it, just my experience.
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I understand what you’re saying, and have certainly seen some Docs wanting to avoid out of pure “laziness”. As to my own opinion, I just keep going back to “risks/rewards”.

I can justify a general anesthetic (and the risks that come with it) or an a-line or central line for someone getting a CABG. It might add 10-20 years to their life. I can justify an anesthetic for an appy/bowel resection/lap chole, because, again, it can save their life, or perhaps alleviate MONTHS of pain.

People are willing to take certain risks, when it comes to living longer, or getting relief from something that has caused pain for a long time/could cause pain the rest of their life.

However, when you ask folks “Are you willing to risk lifelong limb paralysis, for 1-2 days of pain relief??”, most don’t look at that as a worthwhile “gamble”. They certainly don’t if they LOSE that gamble.

I’ve had some high school and college athletes, and you can tell their “dream” is to someday play “pro-ball”. Sure, the odds of that are slim, but I’m not gonna be the one that squashes that dream, just to get them out the door a couple hours faster, or to reduce their discomfort for a day or two. I’ve given them the option to have the block in PACU, if the pain is unbearable. None have required it. If someone can show me that outcomes are significantly better, or that lots of folks were getting addicted to narcotics because of increased pain in the first couple of days, I’m all ears.

Anyway, I’ll stop harping on this, and let folks get back to discussing the “job”….
 
All signs the ad points to is the previous group /or even amc left the practice or the full time anesthesia doc left for x reason.

Whether to retire, or prn, or make money elsewhere

At least it’s not a workman’s comp place. Stay away from those type of ortho cases as outpatient.
 
DirtDocMD said:
I understand what you’re saying, and have certainly seen some Docs wanting to avoid out of pure “laziness”. As to my own opinion, I just keep going back to “risks/rewards”.

I can justify a general anesthetic (and the risks that come with it) or an a-line or central line for someone getting a CABG. It might add 10-20 years to their life. I can justify an anesthetic for an appy/bowel resection/lap chole, because, again, it can save their life, or perhaps alleviate MONTHS of pain.

People are willing to take certain risks, when it comes to living longer, or getting relief from something that has caused pain for a long time/could cause pain the rest of their life.

However, when you ask folks “Are you willing to risk lifelong limb paralysis, for 1-2 days of pain relief??”, most don’t look at that as a worthwhile “gamble”. They certainly don’t if they LOSE that gamble.

I’ve had some high school and college athletes, and you can tell their “dream” is to someday play “pro-ball”. Sure, the odds of that are slim, but I’m not gonna be the one that squashes that dream, just to get them out the door a couple hours faster, or to reduce their discomfort for a day or two. I’ve given them the option to have the block in PACU, if the pain is unbearable. None have required it. If someone can show me that outcomes are significantly better, or that lots of folks were getting addicted to narcotics because of increased pain in the first couple of days, I’m all ears.

Anyway, I’ll stop harping on this, and let folks get back to discussing the “job”….
Click to expand...
Yup, I’d never block a young person with aspirations of becoming great at a sport.

I save the blocks for fistulas and total shoulders mostly. Generally it’s folks over 60 who will want them
 
PainInTheAnes said:
Yup, I’d never block a young person with aspirations of becoming great at a sport.

I save the blocks for fistulas and total shoulders mostly. Generally it’s folks over 60 who will want them
Click to expand...


Some subtle residual weakness is likely not a big deal to many of our patients. But even if they don’t have any aspiration to be “great”, missing a single season due to residual quad weakness can be a big deal to a HS or college athlete. I’m all for tailoring care to each patient and situation.
 
coffeebythelake said:
For those getting back to doing blocks, such as myself after years of academia, it is hard to develop proficiency when ortho breathing down your neck and being little bitches about being too slow.
Click to expand...

When coming to any new facility, the ortho docs are the worst to work with. Add the block bull**** on top, and that’s the end.
 
DirtDocMD said:
I understand what you’re saying, and have certainly seen some Docs wanting to avoid out of pure “laziness”. As to my own opinion, I just keep going back to “risks/rewards”.

I can justify a general anesthetic (and the risks that come with it) or an a-line or central line for someone getting a CABG. It might add 10-20 years to their life. I can justify an anesthetic for an appy/bowel resection/lap chole, because, again, it can save their life, or perhaps alleviate MONTHS of pain.

People are willing to take certain risks, when it comes to living longer, or getting relief from something that has caused pain for a long time/could cause pain the rest of their life.

However, when you ask folks “Are you willing to risk lifelong limb paralysis, for 1-2 days of pain relief??”, most don’t look at that as a worthwhile “gamble”. They certainly don’t if they LOSE that gamble.

I’ve had some high school and college athletes, and you can tell their “dream” is to someday play “pro-ball”. Sure, the odds of that are slim, but I’m not gonna be the one that squashes that dream, just to get them out the door a couple hours faster, or to reduce their discomfort for a day or two. I’ve given them the option to have the block in PACU, if the pain is unbearable. None have required it. If someone can show me that outcomes are significantly better, or that lots of folks were getting addicted to narcotics because of increased pain in the first couple of days, I’m all ears.

Anyway, I’ll stop harping on this, and let folks get back to discussing the “job”….
Click to expand...
Do you do labor epidurals?

They aren’t really “necessary” and carry the same hypothetical risks (and then some) for 1-2 days of pain relief.
 
PainInTheAnes said:
Yup, I’d never block a young person with aspirations of becoming great at a sport.

I save the blocks for fistulas and total shoulders mostly. Generally it’s folks over 60 who will want them
Click to expand...

I was taught early on to avoid blocks in high level high school and college athletes. When I extrapolate that line of thinking, though, it has made me more conservative about who I offer blocks to.
 
DirtDocMD said:
Last figures I saw for “ASA Closed Claims”, had (other than death) nerve block injuries as the most likely reason to get sued.

The increasing push to “do a block” for any/everything over the last 5-10 years, doesn’t fit into a risk/benefit profile that’s to my liking (“Hey! How would you like to risk lifelong limb paralysis, for 1-2 days of improved pain relief???!!!!).

I know some of you guys will tell me you’ve never seen or had a single complication with your nerve blocks. Congrats…..I’ve managed to dodge that bullet (so far). I’ve had partners get some scary phone calls.

Maybe I’m just an old “fuddy-duddy”, but dealing with a bunch of primadonna ortho surgeons, and doing 10-15 blocks a DAY (increasing the possiblility of lawsuit exposure, vs. my usual of 10-15 a MONTH) doesn’t appeal to me.
Click to expand...
I have a good friend that is an exceptional regional anesthesiologist.
Had a TSA where the patient ended up with a very serious nerve injury. Hard to tell if it’s a nerve traction injury during the TSA (very common) or the nerve block itself.
Needless to say it is very concerning- patient, anesthesiologist and orthopedic surgeon losing sleep over it.
It happens. Thankfully not often.
But to be fair, if you do anything long enough you’re likely to get a complication.
 
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sevoflurane said:
I have a good friend that is an exceptional regional anesthesiologist.
Had a TSA where the patient ended up with a very serious nerve injury. Hard to tell if it’s a nerve traction injury during the TSA (very common) or the nerve block itself.
Needless to say it is very concerning- patient, anesthesiologist and orthopedic surgeon loose sleep over it.
It happens. Thankfully not often.
But to be fair, if you do anything long enough you’re likely to get a complication.
Click to expand...
lose*
 
DesiredMemberName? said:
Do you do labor epidurals?

They aren’t really “necessary” and carry the same hypothetical risks (and then some) for 1-2 days of pain relief.
Click to expand...
One of the benefits of my job, is that I haven’t done a labor epidural, or dealt with a laboring patient, or even had to deal with an L&D nurse, for 15 years…..😜
 
DirtDocMD said:
One of the benefits of my job, is that I haven’t done a labor epidural, or dealt with a laboring patient, or even had to deal with an L&D nurse, for 15 years…..😜
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Ok… I probably should’ve guessed as much.

Let me rephrase: Do you believe that labor epidurals should not be placed because the risks outweigh the benefits?
 
PainInTheAnes said:
Are you serious in asking this question?

Pain from labor is a little different than pain from a shoulder arthroplasty.
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Labor epidurals are elective in many counties. It’s just over used in the USA. Just like everything healthcare wise

Canada has lower labor epidural rates.

So does Denmark , holland etc. holland epidural rate is 30% for g1. And a crazy low 10% for muti gravid. I know this first hand cause some idiot labor l and d nurse woke me at 2am up a long time to place an epidural on a g3 Dutch woman who had her other 2 by natural birth in holland. Once I placed the epidural the woman thank me! She said she should have had it the first two times….cause it’s cultural. It’s best we don’t know what’s best for them. It still works fine the natural way with anesthesia.

Why is that?

These are first world countries so lack of anesthesiologists likely doesn’t play a huge factor. It’s cultural.
 
PainInTheAnes said:
Are you serious in asking this question?

Pain from labor is a little different than pain from a shoulder arthroplasty.
Click to expand...
The point is the argument that the extremely low risks of regional blocks outweigh the benefit because analgesia isn’t “necessary” is a bad argument that applies to labor epidurals as well.

But… maybe it is the case that in the hands of someone who hasn’t done a block in 15 years the risks DO outweigh the benefits.
 
mmag said:
Got this in my inbox today. There has to be a catch right?
View attachment 399395
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If it’s advertising “$1,000,000+ over 2 years”, I’d have to confirm if the “20+ weeks out of office” is also over 2 years. And who advertises weeks of vacation as “out of office”. I personally spend 52 weeks a year “out of office” because I only go there to pick up mail. What a used car salesman.
 
aneftp said:
Labor epidurals are elective in many counties. It’s just over used in the USA. Just like everything healthcare wise

Canada has lower labor epidural rates.

So does Denmark , holland etc. holland epidural rate is 30% for g1. And a crazy low 10% for muti gravid. I know this first hand cause some idiot labor l and d nurse woke me at 2am up a long time to place an epidural on a g3 Dutch woman who had her other 2 by natural birth in holland. Once I placed the epidural the woman thank me! She said she should have had it the first two times….cause it’s cultural. It’s best we don’t know what’s best for them. It still works fine the natural way with anesthesia.

Why is that?

These are first world countries so lack of anesthesiologists likely doesn’t play a huge factor. It’s cultural.
Click to expand...


Not to get too off topic but medicine is often very cultural. For example Brazil has a C-section rate that is >50% but in their private hospitals that serve wealthy women, the C-section rates are 70-80%. Korea also has very high C-section rates. Medicine is not immune to fashion.
 
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Not sure where this hesitancy to do blocks is coming from. I trained at D1 college program and we would do blocks on their athletes all the time. The Andrews Institute which is known for treating professional athletes is also very heavy into regional anesthesia and even offers a fellowship. I get that there are risks to performing a block but with ultrasound guidance and a skilled provider the benefits outweigh the risks.
 
ssmallz said:
Not sure where this hesitancy to do blocks is coming from. I trained at D1 college program and we would do blocks on their athletes all the time. The Andrews Institute which is known for treating professional athletes is also very heavy into regional anesthesia and even offers a fellowship. I get that there are risks to performing a block but with ultrasound guidance and a skilled provider the benefits outweigh the risks.
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I think this presentation brought the topic to the attention of orthopedic sports docs. Around that time, I remember our partners at our childrens hospital stopped blocking athletes getting ACLRs at the request of the orthopedists. Some subsequent studies affirmed the findings while others did not.

Femoral nerve blocks delay recovery after ACL reconstruction | MDedge

medauth2.mdedge.com medauth2.mdedge.com

“SEATTLE – Postoperative femoral nerve blocks prolong quadricep and hamstring weakness after anterior cruciate ligament reconstruction in young athletes, and delay recovery, according to investigators from the Mayo Clinic in Rochester, Minn.

Because of that, "I’ve stopped using them," said investigator Dr. Amy McIntosh, a pediatric orthopedic surgeon in Rochester.




M. Alexander Otto/Frontline Medical News
Dr. Amy McIntosh
In a retrospective study of patients no older than 18 years, her team found that 68% (42 of 62 patients) who got the block – weight-based bupivacaine HCl in all cases – were cleared for sports at 6 months, meaning that their operated knee was at least 85% as strong as their uninjured knee, and at least 90% as functional. Among children who didn’t get the blocks after anterior cruciate ligament reconstruction (ACL), 90% (56 of 62) were ready to return to sports, a significant difference. Overall, unblocked kids were 4.4 times more likely to be cleared at 6 months.

"Kids who didn’t clear at 6 months usually took another 3-4 months. At a year, everybody looked about the same," Dr. McIntosh said at the American Orthopaedic Society for Sports Medicine annual meeting.

Also at 6 months, kids who got the nerve block had significantly greater mean deficits in fast isokinetic knee extensions, a measure of quadricep strength (17.6% in the operated knee vs. 11.2% in the uninjured knee), and fast (9.9% vs. 5.7%) and slow (13.0% vs. 8.5%) isokinetic flexion, a measure of hamstring strength. It didn’t seem to matter if they got a one-shot femoral nerve block or a continuous pump infusion.

Dr. McIntosh initially lobbied Mayo anesthesiologists to use femoral blocks in kids, opting first for the pump. "Then I saw that those kids had a lot of quad atrophy and were taking a longer time to get off their crutches, so I started going to the one-shot block, but they still had quad atrophy, and took a little longer to get off their crutches and get their normal gait back. Now, after seeing this data, I’m done with it," she said.

She’s not alone. Long considered a benign and effective method for short-term pain control, surgeons have been reconsidering the blocks because of similar findings in adults.

"I tell patients [and parents] that they have to decide if they want great pain control up front, or a little more pain in the first few days after surgery," but a quicker return to sports. When offered the choice, young athletes opt against the block because it will likely mean missing an entire season. "That’s what matters to these kids," Dr. McIntosh said.

The nerve block group and control groups were evenly matched; children in both were about 16 years old, on average, with a mean body mass index of about 24 kg/m2. There were slightly more girls in the study than boys.

Most of the kids in both groups had patellar tendon autografts, and the rest had hamstring autografts. Those who got nerve blocks had shorter tourniquet (82 vs. 93 minutes), operative (134 vs. 155 minutes.), and anesthesia times (177 vs. 200 minutes).

Dr. McIntosh said he had no relevant financial disclosures. The project was funded internally.“
 
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nimbus said:
Also at 6 months, kids who got the nerve block had significantly greater mean deficits in fast isokinetic knee extensions, a measure of quadricep strength (17.6% in the operated knee vs. 11.2% in the uninjured knee), and fast (9.9% vs. 5.7%) and slow (13.0% vs. 8.5%) isokinetic flexion, a measure of hamstring strength. It didn’t seem to matter if they got a one-shot femoral nerve block or a continuous pump infusion.
Click to expand...
It'd be interesting to rigorously study if kids/athletes who undergo nerve blocks with ACL reconstruction end up with higher re-tear rates due to worse LSI's (limb symmetry index) on return to sport. In the sports med community, it's quite well known that athletes return to sport prematurely post-ACL reconstruction, and even the standard RTS test batteries are an insufficient threshold for RTS.

I know for sure I personally would not want a nerve block if I had to undergo ACL reconstruction.
 
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