CON Single Shot Techniques Best Volkan Hancı, M.D. Dokuz Eylül University Department of Anesthesiology and Reanimation
Single Shot Techniques Dreams: Regional Anesthesia & General Anesthesia Truths: Continuous regional anesthesia & Single shot techniques
Single Shot Techniques
Pain control Best Pain control
Single Shot Techniques Continuous Techniques
Continuous & Single Shot Critical Question –Does Continuous regional anesthesia techniques Always provide better analgesia scores or Outcomes
Continuous & Single Shot
Total Knee Arthroplasty ; Single Shot FNB better pain relief –Single shot PMDI –Continuous PMDI Comparable to that Continuous FNB
Total Knee Arthroplasty; Continuous & Single Injection Femoral Nerve Block Superior PCA alone analgesia
Total Knee Arthroplasty; –Sciatic nerve block + continuous lumbal plexus block –Sciatic nerve block + single injection lumbal plexus block No differences; –Pain scores, –Tramadol consumption
Minor Arthroscopic Shoulder Surgery; Continuous & Single Injection Interscalene Block Similar –Proportion of night slept –Satisfaction
Knee Arthroplasty Continuous Femoral Nerve Block –Ropivacaine –Normal Saline Similar WOMAC scores Similar Health related Quality
Similar WOMAC Scores Knee Arthroplasty Continuous Femoral Nerve Block –Ropivacaine –Normal Saline Similar WOMAC scores Similar Health related Quality
Total Knee Arthroplasty; –Single Shot Adductor Canal Block & –Continuous Adductor Canal Block
Pain control
Similar Ambulation Recovery scores Similar LOS
Total Knee Arthroplasty; –Single Injection Femoral Nerve Block (SFNB) & –Continuous Femoral Nerve Block (CFNB)
Pain control
Similar Ambulation Recovery scores Similar LOS Similar Range of movement
Similar VAS Scores Similar Range of movement Similar LOS
Total Knee Arthroplasty; –Single-Injection Adductor Canal Block –Continuous Femoral Nerve Catheter
Similar Pain Scores Ambulation Distance ACB>FNC LOS ACB<FNC
Continuous & Single Shot Critical Question –Does Continuous regional anesthesia techniques always provide better analgesia scores or outcomes NO
Continuous & Single Shot But Continuous Blocks Want; –Additional Time –Additional Cost (Doctor – Equipment) –Additional Equipment –Additional Education
Additional Skill Education Additional Time Additional Postoperative Management
Additional Time
Additional Cost ????? Equipment Cost 20 US Dollar + Equipment
8-9 Euro Equipment Cost Additional Cost
104 NZD
Continuous & Single Shot But Continuous Blocks Want; –Additional Time –Additional Cost (Doctor – Equipment) –Additional Equipment –Additional Education Additional Complication Risk
Infection Risk Nerve Injury
Infection Risk
Nerve Injury Infection Risk
Technical Problems Due to Catheters and Devices
1398 CPNBs 849 patients Major complications: rare Minor advers effects: more common Minor Advers Effects
1398 CPNBs, 849 patients Major complications: rare Minor advers effects: more common Minor Advers Effects
One patient Retroperitoneal Hematoma Acetylsalicylic acid: 1 g/day Antithrombotic or Thrombolytic Therapy
Continuous
5083 patients; Non-obstetric Epidural Anesthesia Major complication: %1.36; Post-op neurologic deficit: %1.12 Risk Factors; ASA II-III, Orthopedic surgery, Multiple attempts, Paresthesia, PCEA
Incorrect Placement
Migration
Knotting
Breakage
Infection
Haemorragic Complications
Leakage- Contamination
Incorrect Placement - Migration MORTALITY
Other Side of the Coin
Surgeons’ View
Survey 96 response %58.7: SSISB %15: CISB %26.3: None Surgeons’ View
Survey 96 response %58.7: SSISB %15: CISB %26.3: None Surgeons’ View
Rudin was still not convinced Inadequate Block Time; Block Duration < Surgical Time
Neosaxitoxin
5 Fold Longer than Bup
Conclusion Continuous & Single Shot –Provide similary outcomes Range of movement Ambulation scores LOS Single Shot Techniques –No Additional Time Cost Equipment Education Complication (related catheter)
Thank You
CON Single Shot Techniques Best Volkan Hancı; M.D.; Assoc. Prof. Dokuz Eylül University Department of Anesthesiology and Reanimation Inciralti / Izmir - Turkey