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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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