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Archive Opioids 2020

Nerve Blocks Are a No-Brainer

Are your patients missing out on regional anesthesia's targeted pain relief that reduces the need for opioids?

Jared Bilski

BIO

ROOM FOR IMPROVEMENT
Pamela Bevelhymer, RN, BSN, CNOR
ROOM FOR IMPROVEMENT Of all the outpatient procedures that are eligible for a nerve block, only about 3% will actually involve one.

Nerve blocks are the most targeted form of analgesia available, arming your anesthesia providers with the ability to direct local anesthetics to specific areas of the body to prevent pain impulses from reaching the brain. Given the scope of the opioid epidemic, you’d expect every eligible patient to be on the receiving end of an expertly placed peripheral nerve block (PNB). Oddly enough, that’s not the case. A September 2017 study in Anesthesia & Analgesia (osmag.net/J5xoGN) that examined the use of regional anesthesia for outpatient surgery procedures found that regional anesthesia was used sparingly:

  • Frequency was only 3.3% of the 3.3 million possible cases that were amenable to a PNB.
  • PNB frequency of the brachial plexus (6.1%), sciatic nerve (1.5%) and femoral nerve (1.9%) was similarly low.
  • The procedures in which PNBs were most frequently used were shoulder arthroscopies (41%) and anterior cruciate ligament reconstruction (32%). Countless patients are missing out on targeted pain relief that can reduce opioid use, shorten stays in recovery and lower readmission rates. We talked to leading experts in regional anesthesia to find out how they’re taking advantage of blocks.

Local assistance

TRIED AND TRUE
Pamela Bevelhymer, RN, BSN, CNOR
TRIED AND TRUE Patients who receive nerve blocks are less prone to opioid-associated side effects like respiratory distress or PONV, and are discharged more quickly following surgery.

Regional blocks are typically placed with the assistance of ultrasound guidance, which offers anesthesia providers great image quality and granular detail of anatomy to help them home in on specific nerve locations. For example, interscalene blocks cover most of the brachial plexus but spare the ulnar nerve, and are widely accepted as the gold standard for providing analgesia during notoriously painful shoulder surgeries.

“Ultrasound imaging technology lets anesthesia providers identify the interscalene nerve, and inject 20cc to 30cc of bupivacaine or ropivacaine,” says Tong J (TJ) Gan, MD, MBA, MHS, FRCA, professor and chairman of the department of anesthesiology at Stony Brook (N.Y.) University.

This is just one of the many blocks anesthesia providers have at their disposal to keep patients’ post-op pain at bay without resorting to powerful painkillers. What’s more, innovations in regional anesthesia offer clinicians more targeted pain control methods. For example, the quadratus lumborum (QL) block is emerging as a superior option to TAP (transversus abdominis plane) blocks for abdominal surgeries. When placing a QL block, anesthesia providers inject a local anesthetic posterior to the QL muscle, the deepest abdominal muscle located in the back on either side of lumbar spine.

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