The one overriding benefit of regional anesthesia techniques is that they do not need to end as the patient leaves the operating room at the end of the intraoperative period.
The patient education and expectation-setting process is most effective if started in the surgeon's office at the time of the visit at which the decision for operation is completed. Both the surgeon and the nurses need to understand the general concepts and goals of anesthesia and are often strong coadvocates of better perioperative analgesia for their patients.
The perioperative period should be designed so that regional anesthesia does not delay or slow down a surgical day. Perceived surgical delay is one of the most important items to avoid if you desire to successfully add regional anesthetic techniques to your practice.
Regional anesthesia techniques should be selected and performed on the basis of clear indications to maximize benefit and minimize complications.
The preoperative anesthetic note should clearly outline that the patient has been informed of the risks and benefits of the entire anesthetic experience, including the regional anesthetic portion, if that is applicable to the patient. In addition, any preexisting neurologic deficits should be documented on the preanesthetic assessment.
Patients should have regional anesthetics performed in settings where full monitoring, resuscitation equipment, and supplies are available.
When a practice adds continuous regional anesthetic techniques (either epidural or continuous peripheral nerve block techniques), it is important that round-the-clock coverage and follow-up is available to the patient and hospital if the patient remains as an inpatient or the patient is discharged to an out-of-hospital setting.
One of the most important technical items in the intraoperative period with regional anesthesia is to recognize that if a block is not 100%, the anesthesiologist should be the only individual aware of that fact. This means that if the block is not working as well as desired, general anesthesia or deep sedation should be added efficiently.
If a patient is to be discharged with a continuous catheter technique, a clear understanding of catheter and pump management, limb protection, catheter removal, breakthrough pain control, and contact numbers must be assured.
Anesthesiologists need to continue their own regional anesthesia education by attending continuing education conferences and workshops that help them to have a more complete understanding of the topic and learn new techniques for introduction into their practice. This enables anesthesiologists to continue the education of physicians, nurses, and others regarding regional anesthesia advances.
Incorporating regional anesthesia into an established anesthesia practice demands that the physicians involved understand and make preparations to address the following:
- Management of regional anesthesia through the entire perioperative period
- Clinical indications for the regional anesthetic chosen
- Resources necessary to perform the blocks efficiently, effectively, and safely
- Establishing of an institutional strategy to optimize the introduction of new techniques
Physicians often desire to immediately transfer "techniques" they have learned in workshops into their own practices. That strategy is often destined to fail, as ...