VOLUME 26, ISSUE 2

TAKING THE OUCH OUT OF YOUR ORTHOPEDIC AND OPERATIVE PROCEDURES:

EN VOGUE INTRA-ARTICULAR INJECTION AND ADDUCTOR CANAL VS BREAD AND BUTTER ULTRASOUND GUIDED BLOCKS FOR YOUR PRACTICE

Christoper R. Cook, DO TSA Editor

Michelangelo’s painting is probably one that is familiar to most and demonstrates the story of the Creation of Eve from the Book of Genesis 2:21 “So the Lord caused the man to fall into a deep sleep; and while he was sleeping, He took one of the man’s ribs and then closed up the place of the flesh. Then the Lord God made a woman from the rib he had taken out of the man, he brought her to the man. The man said this is now bone of my bone and flesh of my flesh; she shall be called woman for she was taken out of man.” Many people consider this story special for a multitude of reasons; the creation of woman as a companion to man, the first general anesthetic, but it is the compassion that stands out, the empathy and sympathy of the God of the Bible recognizing Adam would likely not survive or suffer terrible pain during a thoracotomy without anesthesia. With Humor subspecialists in regional anesthesia and acute pain… might be based on the qualifications of the Anesthesiologist, that Adam woke up comfortably, had little to no post op nausea and vomiting, sailed through PACU with flying colors, and had a perfect patient satisfaction survey on discharge.

The first ultrasound assisted block was published by Lagrange in 1978. This was the tip of the iceberg of improving peripheral nerve block techniques and was subsequently followed by B-Mode ultrasound guided blocks published in 1989 by P. Ting and company and then expanded in 1994 by Kapral et al. Thanks to the pioneering work of these investigators, there is a rapidly growing volume of literature on the topic of ultrasound guided peripheral nerve blocks and catheters. As our technology, knowledge base and technical skill improves, visualizing and targeting peripheral nerves is becoming more precise. While human anatomy is not changing by large our ability to visualize and perform interventions upon it is. Unfortunately, the En Vogue with little evidence but all of the hype and intrigue seem to be forced upon Anesthesiology practices, regardless of the subtle but important differences in patient populations, acute pain systems and clinical pathways. That being said, progress for the sake of progress, is not justification for the logical minded. This may turn Anesthesiologists back to the traditional evidence based “Bread and Butter Blocks”.

Joint Injection with Extended Release Local Anesthetics for Joint Arthroplasty.

Michelangelo, The Creation of Eve, from the ceiling of the

Based on current trends, over 4.3 million knee, hip and shoulder arthroplasties are being projected for 2030. With this projected explosion of orthopedic procedures, we can expect to see significant changes to our clinical

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