Excision – Hand
Anesthesia Implications
Position: Supine, one arm extended, one arm tucked
Time: 5-30 min (very short)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No
Blocks: Bier Block
- MAC, Propofol Drip
- MAC, Peripheral Nerve Block, Propofol Drip
These surgeries can be done smoothly using simply a MAC with a propofol drip. If using this approach, a bolus of propofol is usually given 1-2 minutes before the doctor administers the local anesthetic. This is typically the most stimulating time.
However, some surgeons insist on a Bier block. If using this approach, the patient is usually given some sedation (ie. Versed and/or Fentanyl) before the block. The Bier block is performed, and then the patient is immediately given a bolus of propofol and then maintained asleep.
Keep airways close by – they’ll be your friend if the patient is consistently obstructing.
Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms
