The rookie in me would ask what the upside of a spinal is apart from decreased analgesia requirements POD0-1. Can’t imagine trying to position the patient for a spinal + the bleeding risk. GA+FIB might be better for the patient? Happy to be educated and will peruse the articles!
10-20mg Ket and three people to turn, injured side down. Heavy Bupi/Fent/Morph - stable patient, prolonged post op analgesia
Yep love this Ian xx
Would you do it with Clopidogrel on board though? Genuinely curious - been drilled into me *not* to so curious what the thoughts are!
Not in Adelaide buddy 😬
Ask the recovery nurse - delirious patients can’t climb out of bed, low dose IT opiate allows long acting analgesia in a patient who may not be able to ask for it, most of analgesia for the longest period of time (potentially) to name a few…
Still do GA with clopidogrel onboard despite UK guidelines. If severe lung disease and Pulm HTN, I might reconsider, but otherwise inhaled nitric oxide is super useful!
FIB is effective to help position for spinal. Typically use a touch of alfentanil and propofol for the turn. Dexmedetomidine infusion 0.3mcg/kg/hr works nice too if you are patient. Bad side up, plain bupivacaine 0.5% + fent. 1.8-2.5mls depending on pt and exact surgery.
Welcome Hawn!!
Thank for the warm welcome! @dr-amit-pawa.bsky.social got me on to this platform (I avoided bluebird/X like the plague before!). Enjoyable keeping up with the chats!
Hawn! Trust you to chime in and nice to catch you on BSky (your med student from POW days + CCAM last year 🤣). Nice to see you speaking at the Code Blue Conference at UNSW this year; the conference has grown heaps!
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