Case 32: Shortening Postanesthesia Recovery Time After an Epidural. Is It Possible?
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You are assigned to anesthetize a patient for a 30-min knee arthroscopy. The patient is a 38-year-old man, weight 75 kg, height 6′0, and ASA 1, and is scheduled to go home the same day. He is terrified of having a general anesthetic and would like a regional block. The surgeon feels that a lidocaine infiltration of the knee joint will not give sufficient analgesia and suggests a spinal or an epidural block. Since your experience with a sciatic/femoral block is limited, you do not discuss this option with the patient. The patient is agreeable to an epidural or spinal but states that he needs to be out of the hospital by 10 am. He is the first case of the day and you are seeing him at 7 am. You tell him that he may be in the recovery room for 2–3 h before being discharged from the hospital, as the recovery room staff has to follow standard criteria for discharge. You give him an epidural, which works fine. The surgery commences at 7:35 am. Unfortunately, the surgery takes longer than anticipated, and the time of arrival in the recovery room is 8:30 am. On arrival in the recovery room, the patient is awake, cooperative, and with 66% motor block according to Bromage scales . (The scales state that inability to move toes, knees, or hips equals 100% motor block; ability to move toes but not knees equals 66% motor block; ability to partially move knees equals 33% motor block; ability to fully move knees equals no motor block.)
KeywordsEpidural Epidural catheter Analgesia Bromage scale Knee arthroscopy Reversal of epidural anesthesia Recovery room
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