Total Joints and the “fluid situation”

[Southpaw]

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If patients ask to be awake, I generally advise them against it unless they are a surgeon or OR nurse themselves.

It adds too much unpredictability. Sounds, smells, pulling, tugging, coughing..etc. All hard to predict how the patient will respond if they're awake.

Most importantly, I want the OR team to be comfortable and following their routine. If the OR team feels on edge because the patient is awake, or that they can't have their usual banter, it changes the flow and I think that increases the risk of mistakes.

C SXNs are different, as the expectation is to be awake.

This is fair. Though if I need a new joint I’ll ask for a spinal and just bring some AirPods and my phone into the OR to listen to music/watch a movie. I’d prefer staying awake but not conversing or altering the flow of anyone around me.

 

[nimbus]

I wish I could convince a patient to stay awake and use headphones or something. But most people want to be out and not see or hear anything. While I agree sections are done awake, there is a huge motivation factor and culture about seeing the baby while minimizing anesthesia to the baby. Same ladies would probably not be okay with staying awake for other cases (except a cerclage which have same reasons).

I’ve only done 2 cases ever with zero sedation. Both involve anesthesia attendings as patients who are super pro regional and thought GA ruins the brain. I think the general population would need a lot of coaching preop to make something like this work. Plus making small talk for almost 2 hours is sort annoying.

Were the attendings 85 years old?

 

[psychbender]

This is fair. Though if I need a new joint I’ll ask for a spinal and just bring some AirPods and my phone into the OR to listen to music/watch a movie. I’d prefer staying awake but not conversing or altering the flow of anyone around me.

Have actually done that for a colleague. He brought in his noise canceling headphones and I brought my tablet. I think he watched Transformers while they replaced his knee. Same surgeon did a shoulder scope on me while I was awake and talking to him (a nice ISB), and another shoulder scope on an IM resident who was curious about the surgery and wanted to watch.

 

[pgg]

Have actually done that for a colleague. He brought in his noise canceling headphones and I brought my tablet. I think he watched Transformers while they replaced his knee. Same surgeon did a shoulder scope on me while I was awake and talking to him (a nice ISB), and another shoulder scope on an IM resident who was curious about the surgery and wanted to watch.

Idly curious - if someone had offered you Exparel and a 72+ hour block, would you have wanted that over the (I assume) plain bupi/ropi block you got?

 

[psychbender]

Idly curious - if someone had offered you Exparel and a 72+ hour block, would you have wanted that over the (I assume) plain bupi/ropi block you got?

I'm not sure if plain exparel would provide a dense enough block for it to be the sole anesthetic. I added preservative-free dexamethasone and precedex to 0.5% bupi for mine, and had a dense surgical block that lasted for over about 28hrs, followed by a very gradual fade of the block over the rest of POD1. It was great, the only oxy I took was in anticipation of pain before it faded completely (had a bad experience with plain ropi fem/sci for my ACL abruptly wearing off in the middle of the night), but that proved to be unnecessary.

 

[Maz777]

That too. They wanna listen to music or gossip about whatever

Exactly. They want to talk **** and act like a**holes.

 

[NightyNight]

Were the attendings 85 years old?

Lol 60s