Archive Anesthesia 2016

Supercharge Your Continuous Nerve Block Program

These 3 technological advances could make continuous catheters easier to place.

Kendal Gapinski

Kendal Gapinski, Contributing Editor


ultrasound guidance BETTER BLOCKS Many providers who place continuous catheters say that ultrasound guidance helps improve their efficiency.

Continuous nerve blocks can help patients comfortably recover at home from even the most painful procedures with few or no opioids — and their undesirable side effects. Despite this appeal, many facilities shy away from placing CNBs, thinking they're too difficult, too risky or too inefficient to perform routinely. Nearly 70% of the 128 respondents to an Outpatient Surgery Magazine reader survey say their anesthesia providers "rarely" or "never" use continuous catheters with peripheral nerve blocks. Good news if you'd like your providers to place more continuous catheters. Here are 3 technological breakthroughs that may make blocks more efficient and safer to place.

1. Enhanced ultrasound imaging
Though ultrasound guidance hasn't been shown in studies to improve block-placement safety, providers say that its increased use has made it easier to place CNBs in recent years. The latest ultrasound technology has a lot to do with that, says Scott Rigdon, CRNA, of Transcendent Anesthesia and Pain Services in Bozeman, Mont. Not only are today's machines capable of producing sharper images, they're also easier to use, smaller and more affordable. "A few years ago, it was fairly challenging for providers to see what they were doing, to see the tip of the needle and the thread of the catheter within the space near the nerve," he says. "Now, with improved ultrasound, it's just all-around much easier."

Anesthesiologist Adam W. Amundson, MD, of the Mayo Clinic in Rochester, Minn., notes that the latest machines are geared toward smaller outpatient facilities. These point-of-care options often feature touchscreen interfaces, smaller footprints and more mobility than their predecessors.

These features, though, don't necessarily mean a higher price tag, says anesthesiologist Gregory N. Dunn, MD, medical director of the Advanced Family Surgery Center in Oak Ridge, Tenn. Because of that, more facilities can find room in their budgets to purchase a quality ultrasound machine that could shave precious minutes off of a block's placement time. "You can get a pretty decent new unit for around $25,000," says Dr. Dunn. "When I went through training back in 2007, you had to invest in a $90,000 unit to get good image quality. But now, these cheaper options provide images that make it easier and faster to place blocks."

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