|
Post by samrandall on Oct 16, 2008 12:07:45 GMT
Hi All, I removed a Neurovascular HD for a patient in private practice a couple of weeks ago. I infiltrated LA directly underneath the HD, whch was on the plantar aspect of the 1st MPJ. This meant coming into the area from the medial aspect of the 1st MPJ which was rather uncomfortable for the patient. The patient was very, very pleased with the procedure and has booked in to see me again in a couple of weeks to have the same done to a H.Vasc on her other foot, on the 4th MPJ. What I was wondering was this: if I directly inject into this area of the foot I imagine the patient will actually levitate with the pain. I am wondering about blocking the posterior tibial nerve at the ankle. I know it is slightly deep and inferior to the PTA, and I have seen a fair few of the injections done, also I am fairly confident in carrying out the injection, although I haven't done one. The syringes we use are self aspirating, so i will know if i hit the PTA. I am OSCE qualified. So: Am I insured and should I do it?? Any thoughts or guidance? Also, bear in mind I am fleeing the country in a couple of months anyway, so if the procedure goes bad... Sam
|
|
|
Post by Martin Harvey on Oct 16, 2008 15:06:31 GMT
Hi Sam, We do, as a profession, seem to often under-use LA in general practice don't we? Your proposed use sounds eminently sensible to me and i regularly use TB's for all sorts of nasties on the plantar area. Can't confirm on the insurance but as the Institute and Society policies seem pretty similar to each other and mine says "anesthesia by injection" without specifying where, I would personally imagine so - but advise you to check! An OSCE, suitably recorded, upon which you based your treatment decision, would demonstrate due diligance. If you have any doubts on the actual technique why not look up a local Pod Surg' to do a couple of supervised ones with, they do these in their sleep ( I'm sure I heard Liggins distinctly snore when I last saw him do one ) Anyway, it would take more than a couple of months to filter through the Coroners court ;D (note to HPC : the foregoing reference to a Coroners investigation together with the former reference to William J Liggins Bsc (Hons) FPodA FInstChP, Consultant Podiatric Surgeon, is a joke, ie. "a short story or ironic depiction of a situation communicated with the intent of being humorous. These jokes will normally have a punch line that will end the sentence to make it humorous. A joke can also be a single phrase or statement, such as with sarcasm. ..." the use of ;D and is included to highlight this - the explanatory statement : "the use of ;D and is included to highlight this" is to be taken seriously, no joking) (Disclaimer : nothing in this email should be taken as encouragement to kill patients, killing or otherwise harming patients can affect your practice - for an interpretation of this statement see note to HPC above) Best of luck, Martin
|
|
|
Post by dtt on Oct 16, 2008 15:56:09 GMT
Hi Martin Dont you ever change Buddy !! ;D ;D ;D ;D ;D ;D ;D Cheers D
|
|
|
Post by Martin Harvey on Oct 16, 2008 16:08:11 GMT
Hi Dek, trying not to By the way Sam, a good source of regional analgesia info on the web, complete with videos, cadaver dissections etc, is the NYSRA site. If you click on 'Techniques' on the menu it takes you to info on individual blocks etc. The whole site is also worth a look. www.nysora.com/home.shtmlCheers, Martin
|
|
|
Post by billliggins on Oct 17, 2008 16:19:08 GMT
Thanks for that Martin. It was actually a snort - I had a cold!
Sam, I think that most of the professional body's insurances are much the same. They will normally cover you to carry out any procedure for which you have been trained. However, I do suggest that you simply check with your body to ensure coverage. You will be very unlikely to run into trouble, but as you say the PTA is rather large and adjacent to the TN. Your patient will love you!
All the best
Bill
|
|
|
Post by samrandall on Oct 18, 2008 10:28:42 GMT
Thanks very much for the information guys. Aprreciate it!
I will let you know how the procedure goes!
My old university head of year suggested I write it up as a case study for Podiatry Now.. may well do that as I will have time once I leave West Kent PCT.
TTFN, S
|
|
|
Post by samrandall on Oct 21, 2008 12:24:35 GMT
Just as an update, I will be performing 2 tibial blocks under the supervision of a podiatric surgeon on thursday. I have finally found a willing volunteer, and after carefully screening myself have decided that I am fit to be anaesthetised.
Checked it with the Society and I will be covered insurance wise..
Wish me luck!
Sam
p.s. I might get robert to take a couple of photo's.
|
|
|
Post by blinda on Oct 21, 2008 12:41:38 GMT
Hi Sam,
So, you will be performing both blocks on yourself? Would DEFINATELY like to see photos! Better still a vid of you trying to walk after....... ;D
Cheers, Bel
|
|