"Remember the goal is to reduce pain and increase mobility," says
Dr. Kim. "You want to get patients up and moving as quickly as possi-
ble, on the same day whenever you can. Motor-sparing blocks are the
key to this."
2. Extend a nerve block's effect. Here's a simple way to possi-
bly prolong the duration of sensory block of peripheral nerve blocks
in upper limb surgery. Evidence suggests that administering Decadron
(dexamethasone) in conjunction with the local anesthetic around the
nerve (perineural) or into a vein (intravenous) may prolong the dura-
tion of a sensory block, and reduce post-op pain intensity and opioid
consumption.
Researchers examined 35 studies involving 2,702 patients who had
upper limb surgery. They found the steroid can prolong the pain relief
of the initial peripheral nerve block. When compared with placebo, the
duration of sensory block was prolonged in the perineural dexametha-
sone group by 6
1
⁄2 half hours and in the IV dexamethasone group by 6
hours. Researchers say there is not enough evidence to determine the
effectiveness of dexamethasone as an adjuvant to peripheral nerve
blocks in lower limb surgeries and there is no evidence in children.
3. Fast-track spinal anesthesia. A new fast-on, fast-off spinal
anesthetic from B. Braun called Clorotekal (chloroprocaine hydrochlo-
ride) is intended for short procedures that last about 40 minutes —
because that's about how long the anesthetic lasts. Arthur Atchabahian,
MD, of NYU Langone Medical Center, reports that study patients who
underwent procedures with Clorotekal were ready to be discharged 150
minutes after injection, nearly an hour-and-a-half sooner than bupiva-
caine study patients (230 minutes from injection to discharge).
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