Does continuous regional anesthesia/analgesia increase the incidence of shouder and hip dislocations after total joint replacement?! Is there any evidence? What about specific procedures, such as Reverse/Inverse Shoulder Arthroplasty?
Dear friends,
A few years back when more than half of the total hip arthroplasties around the world were still done under neuraxial anesthesia, a prominent chief of orthopedic surgery was suggesting that epidural analgesia was making patients "too comfortable" and therefore prone to dislocations postoperatively...
In a near-deja-vu scenario, there has been fear expressed by shoulder surgeons about the interscalene block increasing the risk of postoperative shoulder dislocation in patients with reverse or inverse total shoulder arthroplasty (which seem to have more stability problems).
Before I completely waive such concerns aside, I would like to ask you, my brethren/sisters-of-the block needle, for your expert opinion and professional experience. Have you heard of or/and do you share similar concerns? Would this be a good time for us to take a look at the outcomes and maybe find out in an organized scientific fashion?
Many thanks and best regards,
Kamen
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Hi all. Have heard of colleagues having excellent results with their InterScalene Blocks for shoulder surgery with combination of 30mL 0.75% bupivicaine mixed with 10mL 2% lidocaine and 8 mg decadron to give final solution of 40mL 0.56% bupivicaine+0.5% lidocaine+8 mg decadron. Analgesia lasts reportedly around 36 hours with a single shot technique administered under US guidance. Wondering if anyone has any experience using the same or similar mix for single shot US guided Femoral nerve blocks for total knee arthroplasty. Concerns seem to be prolonged quadriceps weakness but this is something we experience with continuous femoral nerve catheters and 0.2% ropivicaine infusion when the catheters are left in until post-op day 2. Thank you for any info on this subject.
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I have had recent discussions with colleagues about the use of fentanyl for cardiac and non-cardiac surgery. Very different opinions have been offered for dose and duration of action in adults.
I would like to ask members about their use of fentanyl. This information is for personal interest, and will NOT be published...
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I was recently presented with a lady with abruptio placenta. While she bled a little bit, her vitals were stable and the baby was OK. I did a quick spinal and the outcomes for both the baby and the mother were good. Was my decision correct or do you believe that abrutio placenta is a contra-indication to doing a spinal?
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I was recently presented with a lady with abruptio placenta. While she bled a little bit, her vitals were stable and the baby was OK. I did a quick spinal and the outcomes for both the baby and the mother were good. Was my decision correct or do you believe that abrutio placenta is a contra-indication to doing a spinal?

Thanks for your advice and opinion.
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