Regional Anesthesia Puns

Bowness JS, Pawa A, Turbitt L, et al. International consensus on anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia. Regional Anesthesia & Pain Medicine Published Online First: 22 September 2021.

DOI: 10.1136/rapm-2021-103004

https://rapm.bmj.com/content/early/2021/09/22/rapm-2021-103004

TLDR: What is your institution's use of regional anesthesia for breast cases, and what's the rationale?

Hi all. I'm an M4 applying into anesthesiology and I've been asked to give a short talk to the plastics dept about this topic. I've done my research and put together the talk, but want to make sure it's practically relevant. From talking to attendings at my home institution, it seems that we use PECS II for the majority of large breast cases (I.e. mastectomy w/ reconstruction). Alternatives, in decreasing level of frequency, are serratus anterior block, erector spinae block, and a thoracic paravertebral block. But when I press attendings for when or why to use one block over another, no one has a good answer - it seems to be physician preference.

I'm curious if it's also attending or surgeon dependent at other institutions, and if not, what is the rationale behind specific indications?

Thanks in advance for any input!

ETA: Thanks for all the responses! It looks like there is some institution-based variability PECS II vs ESP vs paravertebral (understanding that approaches also vary by operation). I'll be able to bring this up as a learning point in my talk, and it was educational for me! - M4 excited to learn more

I’m need spigelian hernia repair surgery. I was thinking of asking if it’s possible to use a spinal block and sedation rather then general anesthesia. Is this something that is even possible?

Sorry very uninformed Anesthesia question.

Hello all,

I am an SRNA that will soon be applying to jobs. One of the things I want in a first job is regional experience. ..Which is one of the weaknesses of my program. We get about a month or so of regional at an out of state hospital but that’s it. I want to learn at least a basic level of it so I can be more marketable should I want to move across the country etc in a few years. I also think it is just an awesome thing to know and great for patients.

My question is, how likely is it to be able to find somewhere where CRNAs do most of the regional AND would be willing to help train someone with minimal experience in RA? Is this even possible?

Thanks for any input!

I know the focus is different, however the skillset is that different at the end? Regarding blocks and US skills

What you chose?

CW: Discussions about pain and anesthesia
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Hi all,

I wanted to check in with other folks who have experienced IVF egg retrievals using twilight sedation.

I had my retrieval on Monday, and was very surprised by how much pain I felt during the procedure, as I expected to feel pressure, but not pain. In reflecting on my other experiences, I'm a bit worried that I may not respond to anesthesia. The only other experiences I've had are with a local injectable anesthetic used during the extraction of my wisdom teeth, in which the anesthesia did not work. I felt the entire thing and it was very traumatic. I took two vicodin after the procedure and while they made me feel groggy, they didn't numb the pain. Similarly, I had an IUD inserted 1 week following a medical abortion. My cervix was definitely NOT numbed by the local anesthetic administered and I nearly jumped off the table. Since I've had relatively few experiences with anesthesia, I am now dreading additional procedures.

I've reached out to my medical team for additional conversation, but I am wondering if other people have similar experiences? I've seen a few posts where people have asked about the pain during retrievals, and the vast majority of the responses have been, "I was sedated and didn't feel a thing." Does anyone have formal confirmation of being resistant to local or regional anesthesia? TIA!

Wednesday I’ll have my first surgery ever which has completely blindsided me because I thought it would be next month but they called sooner making it seem much more urgent than I thought before. I am sooo afraid of going under general anesthesia and and having a breathing tube. I’m considering asking them if they can do it without putting me completely under. Does anyone here think that is possible with this kind of surgery? (They’re checking for cysts, fibroids, polyps, and endometriosis)

Have a big ass 25mm kidney stone in my left kidney that needs to come out soon or else I'll be out 1 kidney. A stone that large won't be able to pass on its own and from the scans it's looking like its calcium-based so I won't be able to dissolve it on my own either. To get it out I'll have to have a procedure done, and I have 3 options: Lithiotripsy, Ureteroscopy or a PERC.

If I can I'd like to do one that can be done with either local or regional, this isn't the first time I've gone under, back when I was 5 (I'm 26) I broke my arm and had surgery via general. However alot has chaged since then, most notably that I'm pretty sure I developed sleep apnea, GERD and maybe even asthma (I definitely have allergic rhinitis to dust which has only gotten worse over the years that these days I can barely breathe through my nose)

It was also recently discovered that I have scoliosis, unfortunately I don't know to what extent I have it so it could very well be possible that I have the severe kind that makes breathing difficult.

In short I probably have a host of breathing problems and so am reluctant to do or take anything that can depress breathing. I already know all the risks of General but can even local or regional have the risk of affecting breathing? At first I thought they were much safer cause the only risk with those two types are paralysis or nerve damage. However I recently came across one article that said even local anesthesia has the very rare risk of depressing the Central Nervous System, which includes breathing. Is that true? Do all forms of anesthesia have breathing risks no matter what?

How come the local and regional types are considered "less risky" then? How are they less risky if they all have the risk to depress breathing?

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The technique not only reduces pain, but allows patients to maintain muscle strength in the leg.

Regional anesthesia improves outcomes for total knee replacement

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• DOI/PMID/ISBN: 10.5301/jva.5000683

• URL

Hi everyone. I’m a 23 year old female. No health problems although I do have a History of asthma (rarely affects me) and I take birth control on a daily basis.

Next Friday 1/4 I will be getting arthroscopic surgery to repair a UT split tear in my wrist.

This isn’t my first upper extremity surgery - I had a volar plate/FSD repair a few years ago.

I have a few questions regarding the anesthesia:

1. I currently have a bit of a cough/cold that I seem to be getting over. Do I need to mention this prior to surgery? I have no had a fever. Simply just stuffy nose and dry cough.

2. Does every anesthesiologists have their own preferred cocktails of drugs? When I had surgery previously, I responded very well to the drugs I was given and recovery was a breeze. I’m having surgery at the same place, do they typically use the same drugs used previously or does it depend on the doctor?

https://www.amazon.com/Atlas-Sonoanatomy-Regional-Anesthesia-Medicine-ebook/dp/B077TL24S3

I want this book, waiting for offers :)

• Citation: Oxford University Press; 2 edition (November 1, 2016)

• DOI/PMID/ISBN: ISBN-10: 0190231807 ISBN-13: 978-0190231804

• URL

I'm about to have ureteroscopy on Tuesday to try to zap a stone that's halfway between one of my kidneys and my bladder. My urologist seems to favor general anesthesia, but we didn't really discuss the options. I'm a registered nurse, and in the past I had an angiogram performed with only local anesthesia when usually patients are knocked out for the procedure. I did fine with that one.

I found this paper that seems to suggest that spinal (regional) anesthesia works pretty well for most patients. http://jcpsp.pk/archive/2008/Mar2008/09.pdf

I plan to call my urologist's office in the morning to ask her opinion, but I wondered if anyone here could offer their perspective on the anesthesia options. Do you recommend one option over the other, and if so, why?

Edit: thank you guys. I spoke with the doctor's medical assistant. The Dr. does want me under general anesthesia to prevent me from moving, to help prevent trauma to my ureter. Part of it I think is her preference, part of it may be that I have what would apparently qualify under the study I linked to to be an "upper ureteral stone" (above the SI joint), which would have excluded me from the study group. So here's to a safe and successful surgery tomorrow!

Edit 2: Had the procedure. The anesthesiologist also thought that being knocked out was a good idea. So we went with that. I'm recovering pretty nicely from the anesthesia, and from the procedure.

As the title says I am not fully decided either way Anesthesia or emergency medicine. I want to dual apply but it looks like most anesthesia programs are associated with EM programs at the same hospitals.

How do you go about applying without pissing off PDs? Anyone ever do this before or with another specialty?

Im a DO student with regional preference for the North East. Any help is appreciated.