8 keys to success with continuous nerve blocks.
Jerome Adams, MD, MPH; and Kevin Backfish, MD; and Ryan Nagy, MD
As we enter a new era of perioperative analgesia that focuses on improving patient recovery and satisfaction while decreasing opioid use, continuous peripheral nerve blocks (CPNBs) are becoming increasingly popular as part of a multimodal analgesia regimen. We're all pretty familiar with the reasons to consider CPNBs in the outpatient setting (see "Making the Case for Continuous Nerve Blocks" on page 40), but what about the keys to successfully administering them? This month we give our list of 8 tips for placing CPNBs. Though not exhaustive, taking this list into account will go a long way toward ensuring success while minimizing delays and complications.
1. Choose the right patient
This is perhaps the most important step to help avoid trouble with CPNBs. You are inserting a foreign device that can cause infection, nerve injury or local anesthetic toxicity. Patients must comprehend instructions and warnings from both a language and an educational standpoint. You should feel you can trust the patient to maintain insertion site integrity, change pump settings if appropriate and to alert you of concerns. The patient must also have realistic expectations in terms of placement, maintenance and analgesia.
2. Choose the right surgeon
You and the surgeon should be on the same page before proceeding with a CPNB, including understanding the time it will take to place the block, the degree and duration of analgesia expected, and common problems that may occur (for example, quadricep weakness with a femoral CPNB). A surgeon who expects pain scores of 0, or who doesn't know that Horner's syndrome from your interscalene block is common and inconsequential, may think poorly of your block — even if it was a complete success in your eyes. Ensure the catheter can be placed without delaying surgery. A dedicated block area is ideal. Also remember you must document that the surgeon actually "requested" the catheter in order to be paid for it. Establishing that he wanted the block can additionally prevent you from being thrown under the bus if complications occur, and help you when requesting more equipment or support.
continuous nerve blocks, perioperative analgesia,... show all keywords
continuous nerve blocks, perioperative analgesia,
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