1. CON Single Shot Techniques Best Volkan Hancı, M.D. Dokuz Eylül University Department of Anesthesiology and Reanimation

2. Single Shot Techniques Dreams: Regional Anesthesia & General Anesthesia Truths: Continuous regional anesthesia & Single shot techniques

3. Single Shot Techniques

4. Pain control Best Pain control

5. Single Shot Techniques Continuous Techniques

6. Continuous & Single Shot Critical Question –Does Continuous regional anesthesia techniques Always provide better analgesia scores or Outcomes

7. Continuous & Single Shot

9. Total Knee Arthroplasty ; Single Shot FNB better pain relief –Single shot PMDI –Continuous PMDI Comparable to that Continuous FNB

10. Total Knee Arthroplasty; Continuous & Single Injection Femoral Nerve Block Superior PCA alone analgesia

11. Total Knee Arthroplasty; –Sciatic nerve block + continuous lumbal plexus block –Sciatic nerve block + single injection lumbal plexus block No differences; –Pain scores, –Tramadol consumption

12. Minor Arthroscopic Shoulder Surgery; Continuous & Single Injection Interscalene Block Similar –Proportion of night slept –Satisfaction

13. Knee Arthroplasty Continuous Femoral Nerve Block –Ropivacaine –Normal Saline Similar WOMAC scores Similar Health related Quality

14. Similar WOMAC Scores Knee Arthroplasty Continuous Femoral Nerve Block –Ropivacaine –Normal Saline Similar WOMAC scores Similar Health related Quality

15. Total Knee Arthroplasty; –Single Shot Adductor Canal Block & –Continuous Adductor Canal Block

16. Pain control

17. Similar Ambulation Recovery scores Similar LOS

18. Total Knee Arthroplasty; –Single Injection Femoral Nerve Block (SFNB) & –Continuous Femoral Nerve Block (CFNB)

19. Pain control

20. Similar Ambulation Recovery scores Similar LOS Similar Range of movement

21. Similar VAS Scores Similar Range of movement Similar LOS

22. Total Knee Arthroplasty; –Single-Injection Adductor Canal Block –Continuous Femoral Nerve Catheter

23. Similar Pain Scores Ambulation Distance ACB>FNC LOS ACB<FNC

24. Continuous & Single Shot Critical Question –Does Continuous regional anesthesia techniques always provide better analgesia scores or outcomes NO

25. Continuous & Single Shot But Continuous Blocks Want; –Additional Time –Additional Cost (Doctor – Equipment) –Additional Equipment –Additional Education

26. Additional Skill Education Additional Time Additional Postoperative Management

28. Additional Time

29. Additional Cost ????? Equipment Cost 20 US Dollar + Equipment

30. 8-9 Euro Equipment Cost Additional Cost

31. 104 NZD

32. Continuous & Single Shot But Continuous Blocks Want; –Additional Time –Additional Cost (Doctor – Equipment) –Additional Equipment –Additional Education Additional Complication Risk

33. Infection Risk Nerve Injury

34. Infection Risk

40. Nerve Injury Infection Risk

41. Technical Problems Due to Catheters and Devices

42. 1398 CPNBs 849 patients Major complications: rare Minor advers effects: more common Minor Advers Effects

43. 1398 CPNBs, 849 patients Major complications: rare Minor advers effects: more common Minor Advers Effects

44. One patient Retroperitoneal Hematoma Acetylsalicylic acid: 1 g/day Antithrombotic or Thrombolytic Therapy

46. Continuous

47. 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

48. Incorrect Placement

49. Migration

50. Knotting

51. Breakage

52. Infection

53. Haemorragic Complications

54. Leakage- Contamination

55. Incorrect Placement - Migration MORTALITY

56. Other Side of the Coin

57. Surgeons’ View

58. Survey 96 response %58.7: SSISB %15: CISB %26.3: None Surgeons’ View

59. Survey 96 response %58.7: SSISB %15: CISB %26.3: None Surgeons’ View

60. Rudin was still not convinced Inadequate Block Time; Block Duration < Surgical Time

61. Neosaxitoxin

62. 5 Fold Longer than Bup

64. 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)

66. Thank You

67. CON Single Shot Techniques Best Volkan Hancı; M.D.; Assoc. Prof. Dokuz Eylül University Department of Anesthesiology and Reanimation Inciralti / Izmir - Turkey vhanci@gmail.com