Re: FW: question for list serve

[Guest guest]

I would say we need some more info. I assume this is to consider weight bearing

after surgery. If so, it would depend on the weight bearing status, return of

strength, sensation, etc... but we do not allow weight bearing unless they have

full sensation and adequate strength.

M. Trevor Huffman, P.T., M.S., S.C.S., A.T.C.

Director of Rehabilitation Services

Passavant Area Hospital

ville, IL

trevor.huffman@...<mailto:trevor.huffman@...\

>

________________________________

From: PTManager [mailto:PTManager ] On Behalf Of

Halek, Kathy

Sent: Thursday, November 01, 2007 7:04 AM

To: ptmanager

Subject: FW: question for list serve

I am sending this question on behalf of the Nurse Manager responsible for our

acute Rehab unit and Inpatient Physical Medicine Services.

thank you,

Kathy Halek, MS SLP

Manager, Outpatient Physical Rehabilitation Services

Danbury Hospital

Danbury, CT

>

>

> Does anyone have experience with treating patients that have had peripheral

nerve block for post op pain? If so what are you doing day of surgery and P.O.

day one to mobilize them, what is your protocol?

[Guest guest]

I am not sure if this is what she is asking. We use Fem blocks on 98% of our TK

patients. First 24 hours they have a knee immobilizer on whenever transferring,

ambulating.

Katesel Strimbeck PT, MS

Glenmont, NY

Katesels@...

FW: question for list serve

I am sending this question on behalf of the Nurse Manager responsible for our

acute Rehab unit and Inpatient Physical Medicine Services.

thank you,

Kathy Halek, MS SLP

Manager, Outpatient Physical Rehabilitation Services

Danbury Hospital

Danbury, CT

>

>

> Does anyone have experience with treating patients that have had peripheral

nerve block for post op pain? If so what are you doing day of surgery and P.O.

day one to mobilize them, what is your protocol?

__________ NOD32 2469 (20070818) Information __________

This message was checked by NOD32 antivirus system.

http://www.eset.com

[Guest guest]

For our TKA we do not see the patient day of surgery. On PO day 1 we

see them bedside, evaluate their needs and determine if their

motor/sensation is impaired by the block. If impairment is noted, the

therapist uses their professional judgment and may use a knee

immobilizer for safety when gait training. They communicate this safety

need to the nurse so they will use it as well when walking the patient.

We also communicate this to the anesthesiologist and they may decrease

the dose or discontinue the block. When the motor/sensation component

returns or the therapist feels the patient no longer needs to use the

knee immobilizer for safety, it is discontinued and nursing is notified.

Otherwise, we don't do anything different when mobilizing the patient.

These patients are WBAT. It is really about communicating the patient's

needs among the team. We page/call one another directly. The skill of

the anesthesiologist really impacts incidence of motor involvement. Our

pain service provided a 30 minute interactive in-service to our staff

explaining the procedure and precautions prior to implementation.

When the blocks have been used for large abdominal surgery we have not

done anything different. These patients do so much better with the

blocks.

Tomazich, PT

Physical Therapy Director

UPMC Passavant McCandless /UPMC Passavant Cranberry

<http://passavant.upmc.com/>

FAX:

" Be kinder than necessary, for everyone you meet is fighting some kind

of battle. "

Any unauthorized or improper disclosure, copying, distribution, or use

of the contents of this e-mail or attached documents is prohibited.

The information contained in this e-mail message is intended only for

the personal and confidential use of the recipient(s) named above. If

you have received this communication in error, please notify the sender

immediately by e-mail and delete the original message.

_____

From: PTManager [mailto:PTManager ] On

Behalf Of Trevor Huffman

Sent: Monday, November 05, 2007 3:53 PM

To: 'PTManager '

Subject: RE: FW: question for list serve

I would say we need some more info. I assume this is to consider weight

bearing after surgery. If so, it would depend on the weight bearing

status, return of strength, sensation, etc... but we do not allow weight

bearing unless they have full sensation and adequate strength.

M. Trevor Huffman, P.T., M.S., S.C.S., A.T.C.

Director of Rehabilitation Services

Passavant Area Hospital

ville, IL

trevor.huffman@...

<mailto:trevor.huffman%40passavanthospital.com>

<mailto:trevor.huffman@...

<mailto:trevor.huffman%40passavanthospital.com> >

________________________________

From: PTManager <mailto:PTManager%40yahoogroups.com>

[mailto:PTManager <mailto:PTManager%40yahoogroups.com> ]

On Behalf Of Halek, Kathy

Sent: Thursday, November 01, 2007 7:04 AM

To: ptmanager <mailto:ptmanager%40yahoogroups.com>

Subject: FW: question for list serve

I am sending this question on behalf of the Nurse Manager responsible

for our acute Rehab unit and Inpatient Physical Medicine Services.

thank you,

Kathy Halek, MS SLP

Manager, Outpatient Physical Rehabilitation Services

Danbury Hospital

Danbury, CT

>

>

> Does anyone have experience with treating patients that have had

peripheral nerve block for post op pain? If so what are you doing day of

surgery and P.O. day one to mobilize them, what is your protocol?

[Guest guest]

On which post-op day is the fem block removed?

FW: question for list serve

I am sending this question on behalf of the Nurse Manager responsible for our

acute Rehab unit and Inpatient Physical Medicine Services.

thank you,

Kathy Halek, MS SLP

Manager, Outpatient Physical Rehabilitation Services

Danbury Hospital

Danbury, CT

>

>

> Does anyone have experience with treating patients that have had peripheral

nerve block for post op pain? If so what are you doing day of surgery and P.O.

day one to mobilize them, what is your protocol?

__________ NOD32 2469 (20070818) Information __________

This message was checked by NOD32 antivirus system.

http://www.eset. com

[Guest guest]

I am pretty sure it is day 0 or 1. I have never worked with a patient when it

is still in, but as supervisor I am not full time on that service. We get our

patients up day 0 if we can get to them and they are cleared, but most we get up

AM the day after surgery and like I said it is out by then. But after 2 falls

with techs, we have a policy UKI for 24 hours (can extend it if PT feels it is

needed, but rarely). No research at our facility, but the fem blocks have

helped with mobility, pain and post op nausea immensely! A real change occurred

when they started using them.

Katesel Strimbeck PT, MS

Glenmont, NY

Katesels@...

FW: question for list serve

I am sending this question on behalf of the Nurse Manager responsible for our

acute Rehab unit and Inpatient Physical Medicine Services.

thank you,

Kathy Halek, MS SLP

Manager, Outpatient Physical Rehabilitation Services

Danbury Hospital

Danbury, CT

>

>

> Does anyone have experience with treating patients that have had peripheral

nerve block for post op pain? If so what are you doing day of surgery and P.O.

day one to mobilize them, what is your protocol?

__________ NOD32 2469 (20070818) Information __________

This message was checked by NOD32 antivirus system.

http://www.eset. com

[Guest guest]

We see our TKA patients in the AM post op Day 1

Some of our patients have femoral nerve blocks and some have an On Q

pump that is used locally near the knee or with the femoral nerve

block. Some of our orthopedists routinely use a knee immobolizer on

all their TKA patients and others do not.

We check quad strength and sensation during the eval. Some patients

can not recruit the quads initially because of decreased sensation

more than because of blocking the innervation to the quad itself. I

have found that working on bilateral quad sets will help some of

these patients recruit the quad on the surgical side and then the

patient is able to ambulate. If the patient's quad is very poor then

we do try to get a knee immobilizer on them the first day.

If the patient can not recruit the quads we do not ambulate.

I asked our anesthesiologist who is the pain/nerve block guru and he

has said that titrating the dose may not have an effect on the

sensation/motor response for some hours.

I do feel that these patients have fewer adverse reactions such as

nausea, vomiting or dizziness than the patients with PCA pumps.

L. Gessner

Chief Physical Therapist

South Nassau Communities Hospital

One Healthy Way

Oceanside, NY 11572

(fax)

>

> I am sending this question on behalf of the Nurse Manager

responsible for our acute Rehab unit and Inpatient Physical Medicine

Services.

>

> thank you,

> Kathy Halek, MS SLP

> Manager, Outpatient Physical Rehabilitation Services

> Danbury Hospital

> Danbury, CT

>

> >

> >

> > Does anyone have experience with treating patients that have had

peripheral nerve block for post op pain? If so what are you doing day

of surgery and P.O. day one to mobilize them, what is your protocol?

>