Which hips get combined spinal/epidural?

[Sonny Crocket]

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How do you guys decide which hip operations get these? Other than surgeon preference.

 

[Idiopathic]

occasionally, an infected three-peat or something that looks like it may take >5 hours, but usually i get by with 15mg isobaric bupiv and clonidine and a little IV propofol.

 

[jetproppilot]

How do you guys decide which hip operations get these? Other than surgeon preference.

All of them, unless there is a contraindication.

 

[drccw]

None of ours....
Our surgeons like to start Lovenox to coumadin ASAP...

Anterior hips get single shot isobaric bupivicaine (which seems to last a long time; I've managed to do bilateral hips on 15mg)...

Lateral hips get lumbar plexus and sciatic single shot blocks....

drccw

 

[Idiopathic]

All of them, unless there is a contraindication.

are you sure you read the question? do you really do CSE for all your hips?

 

[psychbender]

We used to do all of our total hips with CSEs, but that changed about six months ago, and now we do them with lumbar plexus catheters (surgeon preference). Catheter comes out around noon POD#1.

 

[TrustMe]

At my old place almost all hips got a spinal (isobaric bupicicaine 15mg) and a PCA. They did very well. My new place they get lumbar plexus catheter and go to sleep. I don't like this setup, but no one asked my opinion and I don't get to do the joint rooms much yet.

 

[jetproppilot]

What I meant to say was
I use regional on these cases unless there is a contraindication.
I.E. Spinal.
Thanks for pointing out.

 

[Oggg]

Wow, how are you doing your lumbar plexus blocks? Nerve stim or ultrasound or both? How much narcotic are you needing during the case?

And where are you doing your sciatic blocks? Parasacral or Labat? Nerve stim? Ultrasound?

Anyone doing LPB catheter, parasacral sciatic, and SAB?

 

[drccw]

Wow, how are you doing your lumbar plexus blocks? Nerve stim or ultrasound or both? How much narcotic are you needing during the case?

And where are you doing your sciatic blocks? Parasacral or Labat? Nerve stim? Ultrasound?

Anyone doing LPB catheter, parasacral sciatic, and SAB?

LPB- Nerve stim.

Sciatic- Labat's approach. Nerve stim.

I use the US a lot but find that I can't really use it for the deep blocks at all
Generally I don't need to use more than the 100 mcg of fentanyl that I use upfront.

drccw

 

[jetproppilot]

LPB- Nerve stim.

Sciatic- Labat's approach. Nerve stim.

I use the US a lot but find that I can't really use it for the deep blocks at all
Generally I don't need to use more than the 100 mcg of fentanyl that I use upfront.

drccw

Why not just do a spinal?

 

[drccw]

Why not just do a spinal?

Post operative pain relief. Generally get about 16 hours of pain relief for the patient. Our surgeons aren't duramorph fans...

Plus, because I like doing peripheral nerve blocks... they're fun

drccw

 

[Uegis]

For those that are using clonidine in their spinals, how much are you putting in? 75 mcg? I would like to start trying this but concerned about hypotension.

 

[jetproppilot]

Post operative pain relief. Generally get about 16 hours of pain relief for the patient. Our surgeons aren't duramorph fans...

Plus, because I like doing peripheral nerve blocks... they're fun

drccw

👍

 

[1984]

For those that are using clonidine in their spinals, how much are you putting in? 75 mcg? I would like to start trying this but concerned about hypotension.

For our OB spinals we sometimes use 75mcg clonidine and the hypotension is not trivial. You can count on a call from the PACU nurse about an SBP in the 70s which lasts quite some time...usually asymptomatic though. Not sure how 75mcg would effect the total hip population.

 

[Uegis]

For our OB spinals we sometimes use 75mcg clonidine and the hypotension is not trivial. You can count on a call from the PACU nurse about an SBP in the 70s which lasts quite some time...usually asymptomatic though. Not sure how 75mcg would effect the total hip population.

Thanks for the input. Found this article:

http://www.anesthesia-analgesia.org/content/99/4/1231.full.pdf+html

One more thing, anyone doing fascia iliaca blocks for their hips? I've done a few of them and they seem to work pretty well, easy to perform, and can even be done after patient goes to sleep since it is a compartment block. It is especially useful for femur fractures after induction of GA, without any quad stimulation causing pain with lumbar plexus blocks.

 

[Idiopathic]

For our OB spinals we sometimes use 75mcg clonidine and the hypotension is not trivial. You can count on a call from the PACU nurse about an SBP in the 70s which lasts quite some time...usually asymptomatic though. Not sure how 75mcg would effect the total hip population.

Well you are using three times more clonidine than i use and i get zero post section hypotension.

I use 25mcg in both cesarean and for hips/knees

 

[shift_roro]

Does adding clonidine also prolong the motor/sensory block of bupivicaine spinals? or does it act like duramorph and just provide long-acting analgesia? Haven't had any experience with IT clonidine so far...

 

[Idiopathic]

Does adding clonidine also prolong the motor/sensory block of bupivicaine spinals? or does it act like duramorph and just provide long-acting analgesia? Haven't had any experience with IT clonidine so far...

prolongs block duration, so will also prolong motor block. doesnt have much evidence supporting post-block analgesia, unfortunately, but prolongs length and depth of block