ACL/PCL Repair

• Usually young, healthy
• Regional + sedation
• Sciatic N + Lumbar Plexus blocks (either 3-in-1 or psoas compartment, preferred)

Arthroscopy, hip

• Often fairly young
• Muscle relaxation helpful
• GA, ETT

Arthroscopy, knee

• Usually young, healthy
• Local + sedation preferred
• GA, LMA OK
• Consider femoral n block if increased POP

Arthroscopy, shoulder

• If limited surgery: just GA
• If more extensive, or planning to open and repair also: Interscalene block + GA
• GA: LMA acceptable, but usu prefer ETT

Arthroscopy, wrist

• Axillary or infraclavicular block + GA
• Lido or Mepiv; POP not marked
• GA, LMA acceptable

Carpal Tunnel

• Bier Block
• Double cuff
• lido 0.5%, about 0.75 cc/kg (50cc, 250mg, usually)
• consider adding ketorolac 20mg … some (limited) evidence for improved POP
• consider adding ketamine 0.1mg/kg or clonidine 1mcg/kg (avoid ketamine  in older patients) … may help with tourniquet pain
• switch cuffs after 10min
• Give abx before tourniquet inflated!
• Occasionally, local + IVA

Elbow Surgery

• Infraclavicular block + IVA
• If GA, block for POP

Femur Fracture

• Usually older patients
• SAB, isobaric bupiv 6-10mg with fentanyl 10-20mcg

Hand Surgery

• Axillary or infraclavicular block + GA
• Lido or Mepiv; POP not marked, and surgeon can place wrist or digital blocks for longer-lasting block
• GA, LMA acceptable

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Total Hip (THA/THR)

• SAB, CSE, or CSA (surgeon dependent)
• Tetracaine if total muscle relaxation requested
• Isobaric bupiv 12-18mg works well, also
• Add duramorph 0.1-0.2mg

Total Knee (TKA/TKR)

• SAB same as THA
• Consider lumbar plexus block (single or continuous) for POP control – do before SAB
• patellar snap
• thread cath 10 cm
• bup 0.15-0.25%
• can add clonidine 1mcg/ml and use less bupiv (e.g., 0.125%) - synergistic
• 8-10cc/hr continuous, or on PCA: 5cc/hr gtt + 2.5-5ml bolus q20-30min

Almekinders
Accepts blocks or GA

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Bos
Soft tissue tumors
Usu prefers no block

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Bynum
Likes blocks, at least for POP

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Campion
Peds pts
Usu prefers caudals for POP

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Dahners
Prefers no blocks

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Garrett
Prefers blocks only

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Guyton
Likes blocks +/- GA

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Henderson
Peds
Accepts caudals?

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Karas
Likes blocks

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Kelley
Regional or GA

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Lachiewicz
Joints
Prefers CSA with tetracaine

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Minchew
Backs

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Taft
Prefers GA for knee scopes
Accepts blocks for ACLs

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