T
he use of continuous
nerve blocks to man-
age post-op pain pro-
vides many benefits.
Patients require
fewer opioids, which lowers their
risk of opioid misuse and elimi-
nates prolonged PACU stays
caused by opioid-related side
effects such as nausea, vomiting,
urinary retention and sedation.
They leave your facility sooner
and feeling good, which increases
their overall level of satisfaction
with the care you provided and
pleases surgeons who appreciate
answering fewer calls from dis-
tressed patients in pain.
My anesthesia group performs
10 times as many blocks at the
Texas Medical Center's trauma
center than we did when I
became director of regional anes-
thesia five years ago. Our anes-
thesia group also works at the
ambulatory surgery center across
the street, and we just began a
study there to compare the cost
of using blocks as a primary anes-
thetic in place of general anesthe-
sia. We think the study will show
what we already suspect:
Regional anesthesia is significantly less expensive
— and just as safe.
To manage post-op pain, our team administers
single-shot blocks with the option of extending the
analgesia with a catheter attached to a pain pump
or a local injection of extended-release bupiva-
caine — a long-acting, non-opioid medication.
Single-shot blocks with bupivacaine and some sort
of additive such as dexamethasone or clonidine
provide adequate analgesia for 24 hours after the
surgery, with the pain quickly tapering off after
that. After the first post-op day, patients transition
to whatever medication surgeons decide is neces-
sary — acetaminophen, ibuprofen or celecoxib, for
example — and an opioid to control break-through
pain as needed.
Total joint replacement patients are ideal candi-
dates for prolonged block durations because signifi-
N O V E M B E R 2 0 2 0
• O U T P A T I E N T S U R G E R Y . N E T • 5 5
The Case for Continuous Nerve Blocks
New technology and advancing techniques could make
extended pain relief the norm in same-day surgery.
Nadia Hernandez, MD | Houston
BUILDING BLOCK Regional anesthesia can reduce the amount of opioids patients need, which makes for faster discharge
times and increased patient satisfaction.
