Case 2b#

What kind of orders do we need to place for the peripheral nerve catheter we placed? Choose the best answer.

  • A. 0.2% ropivacaine @ 6mL/hr continuous

  • B. 0.5% ropivacaine @ 6mL/hr continuous

  • C. 1/8% bupivacaine @ 15mL bolus q90min

  • D. 1/16% bupivacaine + 2mcg/mL fentanyl @ 6mL/hr

  • E. 2% lidocaine, 10mL bolus

  • F. Test dose (lidocaine 1.5% with epinephrine 5µcg/mL, 3mL bolus)

Answer

A. 0.2% ropivacaine @ 6mL/hr continuous

For peripheral nerve block catheters in which catheter is right next to target nerve, we use constant infusion rate.

Explanation:

A. 0.2% ropivacaine @ 6mL/hr continuous: Best Answer.

B. 0.5% ropivacaine @ 6mL/hr continuous: Higher concentration ropivacaine is used for surgical block to achieve primary regional anesthetic, but not for analgesic block on floor.

C. 1/8% bupivacaine @ 15mL bolus q90min: Intermittent bolus dosing is used mainly for plane blocks in which high volume is needed to flood the plane for local anesthetic to reach the nerves, which are along the plane. This is typically combined with ropivacaine & bupivacaine which has a duration of action of 2-4 hours.

D. 1/16% Bupiviciane + 2mcg/mL Fentanyl @ 6mL/hr: This is our standard epidural infusion. In the epidural space, opioids have a synergistic effect with local anesthetics. This is not the case for peripheral nerve blocks.

E. 2% Lidocaine, 10mL bolus: Used to achieve surgical anesthesia via epidural catheter. Not typically used for nerve blocks.

F. Test Dose (Lidocaine 1.5% with Epinephrine 5µcg/mL, 3mL bolus): Epidural test dose is used to check for intrathecal or intravascular placement of epidural catheter. Not used in nerve blocks.