femoral block or epidural TKR

We seem to be moving decidedly towards the blocks and away from epidurals, although for us they actually take longer to place because we do so many epidurals.

We just do so many darn epidurals - it's what we're used to, and change is sometimes slow in coming. It takes 5 min just to play around with the US machine.

I have been using the U/S on femoral nerve blocks...it does not take me any longer to do the block...in fact, it may reduce the time to do the block as I can see where I am putting the needle instead of searching for the twitch or feeling for the femoral, but the machine can be a little cumbersome to roll around in an OR already set up with tons of ortho equipment. Our U/S machine is a laptop, but I am worried it will fall off something if I take it off its rolling stand.

There is no doubt in my mind the U/S is a safer and quicker technique for interscalene blocks.

Our hospital was game on the U/S machine as they could bill additional anesthesia units for the procedure, and charge a facility fee as well. That covers the cost of the equipment if anyone is considering proposing a purchase for their practice.