Tuesday, June 2, 2015

Spinal Anesthesia for Total Joints

Bupivicaine 0.75% 1.6cc = 12mg
Duramorph 0.1mg

Bupivicaine 0.5% 2.5cc = 12.5mg
Duramorpha 0.1mg

For longer cases

15mg with epi wash or 0.2mg epi
Should last 2.5 hours

Use Isobariac for hip

If only hyperbaric bupivicaine available
For knee - tilt table 15 degrees to operative side
For hip - position patient operative side down for 3 minutes, then while supine for foley tilt table to operative side.

Tranexamic acid contraindicated in patients with PTCA and stent

Nubain 5-10mg Q4 for pruritis

Horacek - no duramorph, tranexams acid 1gm in 50cc ivpb 
Metta prefer GA and Vancomycin and toradol
Gerhart - spinal without duramorph. Tranexamic acid x 2, toradol
Banffy- spinal + ga. Ask for muscle relaxation. +/- femoral nerve block. No duramorph.
Kevin Ehrhart - Spinal no duramorph, 2 doses of Tranexamic Acid
Moreland- Spinal with 100mcg Duramorph

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