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Archive June 2020 XXI, No. 6

Rely on Regional Anesthesia

Advances in tools and techniques have improved the pain-relieving effectiveness of nerve blocks.

Thomas Durick

Thomas Durick, MD


ADDED BENEFITS Ultrasound technology is becoming better, faster, smaller and less expensive.

There's no time like the present to take full advantage of regional anesthesia to manage post-op pain. Nerve blocks are being placed with more precision, patients are recovering faster and with fewer opioids, and nurses are spending less time in recovery dealing with unfavorable outcomes like nausea and vomiting.

I've always been a proponent of placing ultrasound-guided blocks, but realized just how effective they are when I had my rotator cuff arthroscopically repaired and woke up from that traditionally agonizing procedure pain-free. I know from firsthand experience as an anesthesiologist and a patient that the foundation of your facility's multimodal pain management protocols should be built on regional blocks.

1. Ultrasound

While the capabilities of ultrasound-guided technology have grown by leaps and bounds in recent years, the physical size of the equipment has been shrinking. The market is now filled with smaller ultrasound machines ranging from handheld units to devices with tablet-sized viewing screens. Smaller equipment makes for easy portability into procedure rooms and ORs. What's more, manufacturers are equipping these smaller units with the ability to add features through smartphone or tablet applications that bolster functionality and keep them from becoming quickly outdated. Advancements in the quality of the imaging also make it easier for anesthesia providers to zero in on nerve bundles, allowing them to place more accurate blocks and visualize critical structures around the nerve to minimize complications such as inadvertent intravascular injections.

Ultrasound technology that lets anesthesia providers administer targeted nerve blocks has many additional and unequaled diagnostic capabilities for facilities. It's a big reason I'm such a firm believer in instant access to ultrasound in the pre-, intra- and post-op settings. For instance, using ultrasound in the OR can help diagnose a patient's hypotension or sudden rapid heartbeat, which will in turn help the provider apply the correct treatment option and reduce any potential complications. From being able to assess gastric contents (is that patient really NPO?) and pre-op cardiac function to determining intractable post-op pain due to intra-abdominal fluid extravasation after a hip arthroscopy, these machines can do a lot more than simply guide nerve block placement.

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