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Archive Anesthesia 2017

5 Tips for Continuous Nerve Block Success

Seasoned pros share their secrets for managing post-op pain long after patients leave your facility.

Kendal Gapinski

Kendal Gapinski, Contributing Editor


ultrasound guidance SEEING IS BELIEVING Ultrasound guidance lets providers view the location of the needle in relation to targeted nerves, so they have a better idea of where the local anesthesia will spread.

Post-op pain doesn't disappear at discharge, so why should your efforts to lessen it stop then? Combining continuous nerve blocks with ambulatory pumps to infuse surgical sites with pain-relieving agents extends the analgesic efforts of your anesthesia providers and lets you perform more complex procedures in the outpatient setting. We asked a couple regional anesthesia experts for insights on implementing and managing a continuous nerve block program that sends patients home with long-lasting relief from post-op discomfort. Here's their best advice.

1. Inform patients
Make sure patients know what to expect after blocks are placed. If you fail to do that, you're unlikely to succeed with your program. Telling patients that their pain may still be at a 2 or 3 — and not a zero — is crucial. "Oftentimes the initial block has a higher concentration of medication that lasts 18 to 24 hours," says Mitchell Fingerman, MD, an associate professor of anesthesiology at Washington University School of Medicine in St. Louis, Mo. "The block will wear off and the pain pump will take over. Patients will experience pain relief, but not at the same level as the initial block. If you don't explain that, they'll think the pain pump isn't working."

Patients might also experience pain outside of the areas covered by the block. For example, says Dr. Fingerman, patients who receive interscalene nerve blocks for labral repairs could experience some pain in the posterior area of the joint. After arthroscopic procedures, fluid can seep into tissue, causing joint pain where the block doesn't reach. Make sure patients are aware of this possibility.

It's best if patients are introduced to the concept of a continuous nerve block before the day of surgery. Provide your surgeons with information and talking points they can share with patients in the clinic or review how blocks work with patients who come to your facility for pre-op assessments.

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