CON Single Shot Techniques Best

1. CONSingle 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. Single Shot Techniques Pain control Best Pain control Pain control Pain control Pain control

5. Single Shot Techniques ContinuousTechniques

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

7. Continuous & Single Shot

8. 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 KneeArthroplasty; • Continuous & SingleInjectionFemoralNerveBlock • Superior PCA aloneanalgesia

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

15. Total KneeArthroplasty; • SingleShotAdductor Canal Block & • ContinuousAdductor Canal Block

16. Pain control

17. SimilarAmbulation Recovery scores SimilarLOS

18. Total KneeArthroplasty; • SingleInjectionFemoralNerveBlock (SFNB) & • ContinuousFemoralNerveBlock (CFNB)

19. Pain control

20. SimilarLOS SimilarAmbulation Recovery scores SimilarRange of movement

21. SimilarRange of movement SimilarLOS Similar VAS Scores

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

23. SimilarPain 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 ContinuousBlocksWant; • Additional Time • AdditionalCost (Doctor – Equipment) • AdditionalEquipment • AdditionalEducation

26. Additional Postoperative Management AdditionalSkill Education Additional Time

28. Additional Time

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

30. Additional Cost Equipment Cost 8-9 Euro

31. AdditionalCost 104 NZD

32. Continuous & Single Shot • But ContinuousBlocksWant; • Additional Time • AdditionalCost (Doctor – Equipment) • AdditionalEquipment • AdditionalEducation Additional Complication Risk

33. Infection Risk Nerve Injury

34. Infection Risk

35. Infection Risk

38. Infection Risk

39. 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 MinorAdversEffects

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

44. One patient • Retroperitoneal Hematoma • Acetylsalicylic acid: 1 g/day AntithromboticorThrombolyticTherapy

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. IncorrectPlacement

49. Migration

50. Knotting