lar detail of anatomy to help them home in on specific nerve locations. For
example, interscalene blocks cover most of the brachial plexus but spare
the ulnar nerve, and are widely accepted as the gold standard for providing
analgesia during notoriously painful shoulder surgeries.
"Ultrasound imaging technology lets anesthesia providers identify the
interscalene nerve, and inject 20cc to 30cc of bupivacaine or ropivacaine,"
says Tong J (TJ) Gan, MD, MBA, MHS, FRCA, professor and chairman of
the department of anesthesiology at Stony Brook (N.Y.) University.
This is just one of the many blocks anesthesia providers have at their
disposal to keep patients' post-op pain at bay without resorting to power-
ful painkillers. What's more, innovations in regional anesthesia offer clini-
cians more targeted pain control methods. For example, the quadratus
lumborum (QL) block is emerging as a superior option to TAP (transversus
abdominis plane) blocks for abdominal surgeries. When placing a QL
block, anesthesia providers inject a local anesthetic posterior to the QL
muscle, the deepest abdominal muscle located in the back on either side
of lumbar spine.
Providers at Northeastern Anesthesia, an Ariz.-based anesthesia group,
began performing nerve blocks 9 years ago. "Since then, we've seen a
90% reduction in intraoperative and PACU opioid usage, and we write
30% to 40% fewer post-op prescriptions," says Michael A. MacKinnon,
MSN, FNP-C, CRNA, a provider at Northeastern Anesthesia.
"QL blocks are more advanced than TAP blocks and do require more
skill to place," says Mr. MacKinnon. But the benefits are clear. It's a deeper
block that provides more visceral pain control, which is great for outpa-
tient procedures such as hernia repairs, says Mr. MacKinnon.
"QL blocks are replacing TAP blocks because TAP blocks are done
after the nerves supplying sensation to the abdomen have been bifurcat-
ed," says Girish P. Joshi, MBBS, MD, FFARCSI, a professor of anesthesi-
ology and pain management at the University of Texas Southwestern
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