Archive February 2020 XXI, No. 2

The Building Blocks of Regional Anesthesia

A back-to-basics approach is needed to expand the use of one of the most effective ways to manage post-op pain.

Edward Mariano, MD, MAS


TRIED AND TRUE Edward Mariano, MD, MAS, says new procedures aren't necessarily better because they're more complicated than the ones they're designed to replace or improve upon.

We're nearly 20 years into our experience using ultrasound guidance for regional anesthesia, so the growing movement among experts in the field to focus on creating new, more complicated nerve blocks makes sense. These efforts have the best of intentions — to deliver the best possible care to patients with more precise pain-relieving techniques.

The problem is, regional anesthesia is not yet performed by the majority of anesthesia practitioners on a regular basis. In outpatient settings, nerve blocks are used in a mere 3% of surgeries that are eligible for them. Even during shoulder arthroscopies — obvious candidates for regional anesthesia — blocks are used only 41% of the time, giving patients a less-than-a-coin-flip chance of getting one.

If only a small number of anesthesia practitioners are using basic blocks, even fewer understand and perform the newer novel blocks that have emerged. The advent of these often more complicated blocks can easily intimidate some practitioners and convince them to avoid using regional anesthesia at all.

This "complexity bias" has widened the gap between pioneers in the field and anesthesia generalists, and patient care may suffer in the long run. While the pursuit of new techniques is always a worthy one, I also think there needs to be a movement toward getting the most out of the current blocks we have (see "5 Blocks Every Provider Should Know" below).

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