In the May 2013 issue of ASRA News, I want to highlight a special Pro-Con feature dedicated to the controversial topic of regional anesthesia and analgesia in the patient at risk for acute compartment syndrome. I want to personally thank our surgical colleagues from the University of Alberta who were willing to write a thoughtful “Con” article for our newsletter. Before jumping to debate each of their points, we need to give them careful consideration. With the paucity of evidence-based recommendations on this topic, it is crucial to have an open honest dialogue between all members of the healthcare team. This Pro-Con is not meant to provide answers but to provide talking points for an ongoing conversation.
https://kevinreillycollection.com/7gqf1mj1 In my previous position at UCSD, we had a Level 1 trauma center where we would keep one operating room (OR) set up and warm at all times for the occasional direct-to-OR resuscitation. We saw all types of acute and subacute orthopedic trauma, and no two cases were approached the same way. Did I consider regional analgesia for each of these patients? Yes. Did I perform regional analgesia for all of them? https://www.angelinvestmentnetwork.net/em5jcnqn No.
In order to have a meaningful discussion on this topic with our surgical colleagues, we must first be part of the conversation. In the specialty of Regional Anesthesia and Acute Pain Medicine, this means emphasizing more the “Acute Pain Medicine” part than the “Regional Anesthesia” part. The value that we bring to perioperative patient care must be more than just a set of interventional peripheral nerve and neuraxial block techniques. We have to know when these techniques are and are not indicated and have other modalities for analgesia at our disposal when providing consultation on complicated trauma patients. In addition, the service we provide cannot be time-limited. https://www.bobbimccormick.com/0n68a2lc0 How can we say that superior pain control is only available from 7 am to 5 pm not including weekends and holidays?
https://missafricausa.org/pz1jdzcdkkg When it comes down to it, managing patients at risk for compartment syndrome is tough. The benefits of analgesia have to be weighed with the potential for neurovascular compromise. Sometimes you will perform regional analgesic techniques for them; other times you won’t. Sometimes, you will place catheters that you can dose later when the risk profile improves; other times you may be consulted for help later in the hospital stay. Sometimes you will convince the surgeon to preemptively perform fasciotomies in a patient in whom you anticipate a difficult postoperative course. The context for this decision-making will vary from institution to institution, but ongoing communication with the surgical team is indispensible. https://markmadsen.com/2022/11/17/a0nol832 Be a consultant; be available; and continue to be part of the conversation.