Infusing peripheral nerve blocks

I don't know if this topic has been brought up before. I am just looking for some feedback if anyone has had any experience with nerve block infusions. It's like a regional block except a catheter is used. Patient's get a loading bolus for the surgery and then post-op the infusion is start after patient exhibits adequate movement. These nerve blocks are being used a lot on patient with total joint replacements.

I work as an Ortho Rn. I have seen these pumps being used more and more. Which I think is great for acute post-op pain management. Only things is that these pumps are either work good, or they over work or don't work at all. Each is different. I have never seen the same therapeutic management. Most of my knee patients seem to be affected the most. Losing total sensation and movement of their foot. Which clinical makes is hard to assess that patient for complication of the surgery etc. compartment syndrome. I do understand that the purpose to eliminate the pain stimulus and that it's none by using a medication that subjectively effect sensation and alter movement.

Anyone have any other feedback??

Still Awaiting and feedback... Anyone even if you have jsut seen one Ijust want to know if they are being used in other facilities other than my own. Medication that is being used for the infusion is Ropivicaine.

Thanks! Hope to hear from someone!

Roxann,

I am assuming that you are talking about a combination continuous femoral nerve block and sciatic nerve block for knee arthroplasty. The catheter, however, blocks the nerves of the anterior thigh, most of the knee, and the skin on the medial aspect of the lower leg. This catheter has basically nothing to do with the foot. Most people will place this catheter in combination with a sciatic nerve block. The sciatic nerve provides movement and sensation to the foot, except for the saphenous nerve on the medial aspect of lower leg/foot, which is a branch of the femoral nerve. The sciatic nerve block usually lasts up to 24 hours. These blocks are great for intra and postoperative pain management. The pain fibers are blocked prior to surgical stimulation which is a good thing, less pain intra and postop equals less sympathetic stimulation for the patient (pain = HTN, ^ cardiac O2 demand, nausea, stress/anxiety), less opioids used means less opioid related side effects (urinary retention, n/v, resp. depression, etc) both intraop and postop, along with other benefits. It might be a good idea to get together with a member of the anesthesia dept. and talk about the benefits/risks and how you should be assessing the patients with these blocks.

Eric

Still Awaiting and feedback... Anyone even if you have jsut seen one Ijust want to know if they are being used in other facilities other than my own. Medication that is being used for the infusion is Ropivicaine.

Thanks! Hope to hear from someone!

Are you referring to the On-Q pump or the Painbuster ball that is used to quell post-op pain? The ortho surgeons that I work with usually use them on the shoulder cases ( rotator cuff repairs or total shoulders)... I have used them for total joints but only for the elderly and even then, very very rarely. We fill the On-Q pump with .5% Sensorcaine, and give the patients a bolus of 10 cc's before leaving the OR. the On-Q Pump is supose to give the patient 5cc's every 3-4 hours(?something like that. I can't Remember) But I have seen literature where Ropivacaine is also used. the outcomes for the use of the On-Q pump for shoulders is good. The patients, from what I have heard, are able to move their shoulders alot faster during rehab than those that do not get one. we use On-Q pumps alot for plastics also. I guess if it is used on weight bearing joint I guess it could pose a problem for the patients.

Are you referring to the On-Q pump or the Painbuster ball that is used to quell post-op pain? The ortho surgeons that I work with usually use them on the shoulder cases ( rotator cuff repairs or total shoulders)... I have used them for total joints but only for the elderly and even then, very very rarely. We fill the On-Q pump with .5% Sensorcaine, and give the patients a bolus of 10 cc's before leaving the OR. the On-Q Pump is supose to give the patient 5cc's every 3-4 hours(?something like that. I can't Remember) But I have seen literature where Ropivacaine is also used. the outcomes for the use of the On-Q pump for shoulders is good. The patients, from what I have heard, are able to move their shoulders alot faster during rehab than those that do not get one. we use On-Q pumps alot for plastics also. I guess if it is used on weight bearing joint I guess it could pose a problem for the patients.

It's neither of those. I know which you are talking about though inreference to the total shoulder. I have seen what we call a "Zimmer" Which is probably very similar to the Painbust Ball your talking about. The Zimmer is Pressure controled and is only in place to the first dressing change. The Zimmer is used only on shoulders, they also use sersorcaine. The pump I am talking about in our total joint cause are either femoral, sciatic, (knee) or paravetrebral in a hip. They are set up on a pump. I will Find out the name exactly on the PUMP itself. it's set like a EPIDURAL PUMP on a continous infusion no PCA though. It had it's own houraly rate that is controled by the pump. This pumps use ropivicaine. I have seen a Clavicular Block with an infusing pump for fractured ribs, and a elbow reconstruction.

Will re-post with name of peripheral nerve block infusion pump.

ERIC,

Thanks fro your response I actually have had to contact anesthesia mutiple times in relation to these nerve blocks and it seems that who ever is on call at night does not know much about the nerve blocks. That's why I was questioning thier use. So it's either that we have anesthesiologist that know alot about them and like to use them and other that know very little. There have been cases where patient have been over blocked to the point of NO SENSATION AND NO MOVEMENT. Which camoflagued the symptoms of compartment snydome, which lead to the losing his leg. I am sure this is the upmost extreme consequence/side effect. BUT that should have LEAD to EVERYONE in the DEPT. becoming Educated on these peripheral nerve blocks.

Thanks Roxann