Who does your blocks?

[2ndyear]

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I'm a CA-1 anesthesia resident. I recently had an attending try to get me to do a retrobulbar block. The retina fellow and ophtho attending were cool with it, but I did back out of it. I had read about it, but stated that I would much rather start with a peribulbar block if I was going to start sticking needles near the eye.

In the 'real world', is this a useful skill for me to have? You guys are much more familiar with the anatomy of this area, and in talking with other residents, most have not picked up this block. Nonetheless, my attending told me that at some surgery centers, the anesthesiologist is expected to do all the blocks for eye surgery 😱 .

On a completely different note, GI docs have recently pushed the FDA into changing propofol labeling to state that it is not a general anesthetic so they can use it for colonoscopies without anesthesia presence. So far, my experience in the eye room has been 'little propofol for the block, little less for the case'. If given the option of using this drug without an anesthesia provider present, do you think eye surgeons would do so? Just wondering.

 

[Andrew_Doan]

We do our own blocks. However, we CANNOT bill for them. If you learn how to do the block as the anesthesiologist, then you can bill for them.

http://www.medrounds.org/cataract-surgery-greenhorns/2005/09/chapter-3-anesthesia.html

 

[schistosomiasis]

in my fellowship one hospital the anesth. gives blocks. Also my friend in private practice has the anesth. give blocks for her cataracts (she doesn't do topical).

In principle it would be a good skill to have. I think after about doing ten to twenty of them you'd be comfortable doing them.

In practice, most cataract surgeons do their cases under topical anesthesia, when i did cataract surgery I actually preferred the anesthesiologist to give absolutely no IV sedation at all- in my experience if the patient is alert they are more cooperative. Of course, I still want a anesthesiologist in the room if anything happens (I had a great relationship with the anesth. docs at my hospital where I did cataracts). Vitreoretinal surgery still requires blocks.