Rational Use and Pitfalls of Regional Anesthesia for Orthopedic Surgery

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Surgeons often are reluctant to support the use of regional anesthesia for orthopedic surgery. This is because of the perceived “slowing down” of the surgical process, our poor understanding of conditions such as acute compartment syndrome, an alleged block failure rate, especially secondary block failure (all addressed elsewhere in this Symposium), and the perceived (or real) potential of added morbidity caused by regional anesthesia. This reluctance of surgeons, especially toward continuous nerve blocks, is furthered even more by the common perception that patients call their surgeons, not their anesthesiologists, postoperatively when a block is not working. The potential for added morbidity and surgeon reluctance toward its use can only be minimized by performing the appropriate block for the appropriate surgery when properly indicated with the correct equipment and technique, while avoiding situations prone to causing morbidity. This article discusses in some detail when it is appropriate to perform blocks, but perhaps more important, when not to perform blocks, and how to carefully calculate the risks and benefits so the latter outweigh the former.

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