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Anesthesiology Consultants of Marin; Marin General Hospital; Greenbrae, California; kjcacm{at}pacbell.net
To The Editor:
I read with repetitive interest the article by Liu et al. (1) regarding general versus regional anesthesia, as well as the accompanying editorial (2). I say "repetitive" because I have followed the "regional versus general" debate for the last 20 yrs. As a private-practice anesthesiologist working in a demanding, competitive, cost-conscious, production-driven, and surgeon-oriented environment, I simply don't understand the either/or nature of this debate.
My colleagues and I practice in a 150-bed hospital with six inpatient ORs, three surgicenter ORs, and a free-standing surgicenter. We frequently utilize both regional and general anesthesia for the same case. For example, we place interscalene blocks for most shoulder procedures, but still use general anesthesia with an LMA to get the patient through the procedure. Most abdominal procedures, and many knee procedures, are done with an epidural and general anesthesia. We will combine femoral and sciatic blocks for lower extremity procedures if central neuraxial blockade is contraindicated, and still provide general anesthesia for the operation itself. We often combine spinal anesthesia with general anesthesia for hip replacements. The general anesthetic eliminates waiting for the block to set up, and provides complete patient comfort regardless of the surgical duration. The regional anesthetic provides excellent postoperative analgesia, and may also reduce the inflammatory response and prevent central sensitization. And we do not have a block room—all blocks are placed in the operating room.
The trick is finding the appropriate combination of techniques and demonstrating to surgeons the superior pain relief of peripheral nerve blocks, which is obvious after two cases. The benefits are clear to our PACU staff, who get irritated when we do not place blocks. Also, we have become reasonably skilled at placing the blocks, courtesy of recent recruits from Virginia Mason and UCSF. Even old guys like me can learn these techniques. It just requires an ongoing commitment to provide patients the best care possible.
Patients and surgeons have expressed great satisfaction with our routinely combining regional and general anesthesia. Pain-free patients rave about their "painless surgeons," who in turn love to work with the anesthesiologists who make this possible. Our hospital and surgicenter are thrilled with the satisfaction rating patients give their facility. And all of this happiness is just 15 min North of San Francisco.
REFERENCES
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