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Egypt - photo by JoAnn Sturman
It’s late in the afternoon, and you are the last anesthesiologist working at an out patient surgery center. The surgeon tells you there is a 20 year old patient from out of town with a distal radius fracture that must be fixed tonight. The PACU nurse in charge is so conservative that even the most robust patient must be able to solve a second order differential equation before being deemed discharge ready. But you have dinner plans, and the patient, who is prone to motion sickness, would prefer to begin the long drive home as soon as possible following surgery. What’s the best way to deal with these problems?
In this case an infraclavicular block with 30-40 cc’s of equal parts 2% Mepivacaine and 0.5% Bupivacaine with a propofol drip works just like a MAC with all the associated benefits. The block is excellent even for forceful open reductions and tourniquet pain. At the end of the case an awake, pain free and grateful patient will proceed to PACU, but there will be an even happier anesthesiologist, who doesn’t have to miss dinner because of a prolonged babysitting commitment.
Lhasa - photo by JoAnn Sturman
