Regional Block Safety
Re: "The Path to Regional Success" (October, page 47). Regional nerve blocks are wonderful for post-op pain management and are far safer for our patients — provided we don't circumvent the protocols that keep patients safe in the first place. While I agree with most of Dr. Rice's approach to performing more regional nerve blocks, I have great concern about administering a block before the surgeon arrives. Blocks are usually done on sites that have laterality, meaning someone must first identify the right or left side. While the patient, circulator and anesthesia provider play a part in this identification, the surgeon must be the one to mark the site. If you give a block "cold turkey" without benefit of anxiolytics or amnesics, the surgeon hasn't participated in site identification. If your providers slip the patient a little Versed "Mickey" to help with relaxation, that prevents the patient from actively participating in site identification with the surgeon. This is a very dangerous practice if medications are given that could in any way alter a patient's mentation or thought processes.

Glenna Montgomery, RN, BSN
Director of Surgical Services
Yavapai Regional Medical Center East
Prescott Valley, Ariz.
gfmontgo@yrmc.org