icecoldstar

7+ Year Member
Jul 14, 2011
91
1
Status
  1. Pre-Medical
Dumb question, why doesn't ortho learn blocks themselves in their residency training and then do blocks on their own patients for their cases?
 
About the Ads

SaltyDog

West Coast Anesthesiology Ninja
10+ Year Member
Aug 10, 2007
5,104
10,810
The Bight
Status
  1. Attending Physician
wouldn't it make sense to do them cuz blocks takes less than 3 min and it would be easy money for them?

Why do you want to give up that revenue stream?

I think it boils down to training more than anything. Blocks aren’t part of their residency curriculum.
 
  • Like
Reactions: 1 user
Jul 5, 2020
630
1,254
Status
  1. Attending Physician
Many reasons

1) They have enough to do and learn in residency without having to learn someone else's job. They won't even spend time learning management of basic things for their patients like bp or diabetes control. These are guys with 250s, 260s and were rockstars in medical school

2) Surgeons don't get paid a separate fee for blocks. Payers consider pain control as part of surgical fee for a procedure. Whether they do local infiltration with a needle at the site or pick up an ultrasound, they get paid the same. So why bother? The supplies and the ultrasound cost money and it's a lot quicker for them to just place some lido with epi at the site.

3) Blocks take 3 minutes because we as anesthesiologists are good at them. We do a lot, we know the anatomy well and use needles and ultrasounds routinely. But watch someone doing them for the first time. In residency, our ortho residents didn't want us to place blocks because some of our attendings would spend half an hour going up and down the leg with the ultrasound "to really get a good sense of the anatomy". Then the ortho residents will take 5 hours to do a case that should take 45 minutes. I get it, they are learning too but serious double standard.

4) We do our blocks well. They generally provide good pain relief for the patient and there is a lower infection risk as we place the local under sterile conditions away from the surgical site. Same reason why we do the lines instead of the surgeons even though they are completely capable of placing a cvl.
 
  • Like
Reactions: 6 users

Urzuz

7+ Year Member
Aug 24, 2011
582
1,090
Status
  1. Attending Physician
You think people who go into orthopedics want to **** around with a needle and ultrasound? They want to hammer and drill ****
 
  • Like
Reactions: 1 users

kidthor

meep
15+ Year Member
Dec 5, 2005
903
770
Status
  1. Attending Physician
Have you ever seen a surgeon put in a central line in the OR? Talk about a production. If ortho did their own blocks they'd have reps and special devices... and they'd still blame anesthesia for some random surgical complication.

That said, podiatrists do pretty awesome ankle blocks.
 
  • Like
Reactions: 5 users

woopedazz

Baby anaesthetist
5+ Year Member
Feb 8, 2015
246
357
One of the places I've worked had an ortho fellow consistently place FI blocks in ER when doing a #NOF consult if he felt ER/anaesthesia were crap or taking too long. They were honestly better than ER's ****ty US-guided FI/fem/whatever blocks that never worked. He also used to do a few ankle blocks.

I preferred his blocks to ER/some of my colleagues.
 

Maverikk

7+ Year Member
Jun 20, 2013
208
77
Status
  1. Attending Physician
What everyone said above ^, I can't remember the last time I worked an ortho case that used ultrasound

Had a general surgeon with anesthesia family, would do his own tap block with Touhy and a ton of dilute under direct visualization in his ex-laps, they were great blocks.
 
  • Like
Reactions: 1 users

Lecithin5

5+ Year Member
Apr 21, 2015
261
221
I think they’re happy to forgo the 60 bucks (or whatever) that an FI block pays, and stick with their surgery that makes them a bit more money...
 
  • Like
Reactions: 1 user

codeb1ue

10+ Year Member
Nov 13, 2008
173
34
Seattle, WA
Status
  1. Attending Physician
Part of regional block training involves managing complications of regional blocks, including LAST. Managing LAST involves practicing medicine. This last part is a no-go for meaty cheesy ortho boys.
 
  • Like
Reactions: 1 user

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.
About the Ads