Preemptive Pain Management

In a recently published paper, we documented the benefit of the preemptive use of the femoral nerve block, intravenous injections, and local knee injections. The anesthetist uses a peripheral nerve stimulator before the arthroscopy to block the femoral nerve (Fig. 6.4). The dosage is 20cc of 0.25% bupivacaine with adrenaline. The knee joint and the incisions are injected with 20cc of bupivacaine 0.25% with epinephrine and 2mg of morphine. The anesthetist gives 30 mg of Toradol intravenously and 1 gm of Ancef intravenously.

Figure 6.4. The femoral nerve block performed with a nerve stimulator.

The physician is now ready to prepare and drape. Use a tourniquet inflated to 300 mm of mercury. The author uses a Linvatec (Largo, FL) fluid pump that works in coordination with the Apex (Linvatec, Largo, FL) driver system for the shaver and burrs to coordinate the flow level. The leg is flexed over the side of the bed.

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