Would
you sedate the patient for the performance of the femoral and sciatic nerve
blocks and/or during the procedure?
This is controversial and depends on many
factors. Many patients do not want to have any awareness of the operating room
and will only agree to regional anesthesia if they are convinced that this will
be the case. In most instances, sedation facilitates a smoother induction of a
regional anesthetic. Midazolam, fentanyl, or small doses of propofol is
appropriate in this setting. The disadvantages of sedating the patient during
performance of the block are that paresthesias and/or symptoms of local
anesthetic tox-icity (e.g., metallic taste, seizure) will go unnoticed.
Sometimes, patients become disinhibited with sedation, which will interfere
with performance of the block as well.
During the procedure, a propofol infusion
provides adequate sedation. However, the anesthesiologist should be prepared to
treat the negative respiratory and hemody-namic effects of this drug.
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