Outpatient Surgery Center

We spend half of our regional anesthesia time at an outpatient surgery center. All of the procedures done at the OSC are small; it's a freestanding facility without the ability to admit patients overnight, transfuse blood, or even send labs. For anesthesiologists, this is a big deal. We plan for the worst case scenarios and have to ask ourselves what we would do if an emergency happens. As a result, all the cases done at the outpatient surgery center are small cases on relatively healthy patients.

As residents, we only go to the outpatient surgery center for our nerve block rotation. Many of the cases performed are orthopedic; we do knee arthroscopies, ACL repairs, shoulder arthroscopies, wrist and hand surgeries. Many of these procedures can be done entirely under nerve block. For a patient undergoing finger surgery, all the patient received for the entire procedure was mepivicaine for the nerve block and perioperative antibiotics. To me, this is pretty impressive; I'm used to cases that require a handful of medications to complete. To have a patient numb and wide awake for a surgery is an accomplishment, and it's ideal because the patient can go home pretty much after surgery since he got no systemic sedation.

Since outpatient surgeries are quick, we get a lot of nerve blocks. We can do up to fifteen blocks a day in rapid sequence, and it's both satisfying and educational. For surgeries where we don't expect much pain, we design the block to wear off quickly so the patient won't have a numb arm or leg all day. For surgeries with moderate pain, we try to tide the patient over the night be using a long-acting local anesthetic. And for surgeries with severe pain, we can leave in a catheter which the patient goes home with that can infuse local anesthetic for several days. The decision making process is also an important aspect of learning regional anesthesia.