@MichaelBritoUM Same!

@EmergencyBod Yes

@bobfunn @MMC My hospital charges me 3 dollars for a half-rotten apple.

@Chronotrope @Leedsmedic @charlottetr @BJAJournals @MichiIntrona If you take the propofol low enough I find you can usually reconstitute a nice alpha band in most people. Exception, of course, is the elderly/frail, and for some reason in patients with severe Parkinson’s Dementia, almost independent of age.

@spa1982 @a_hueb @dieracg @Nikkhah1 I like them for long cases with tucked arms; no bends in the IV tubing!

@MilanNigam2

@bobfunn @glbryson I have never heard anyone hit the nail so sharply and hysterically on the head with one phrase.

@wongdiagnosis @glbryson And to location in the permanent record as well as to research.

@beckimarshRA Oh I think if you’re doing a TEA then adding IT morphine may do little. But as an alternative to an epidural, it certainly has a measurable effect on postoperative pain. I suspect it is sadly not only in the NHS that compromises must be made in anaesthetic choices.

@DrRobbieErskine @derekedsmith @milliken_don @colinjmccartney @EMARIANOMD That seems to be my observation as well.

@DrRobbieErskine @glauncel @colinjmccartney @EMARIANOMD I think I would as well. But what sparked this post was that I found myself with a particularly intransigent and unobliging surgeon who refuses that her patients receive high quality regional analgesia. So I adapted and did the next best thing; was quite pleased with the result!

@derekedsmith @milliken_don @DrRobbieErskine @colinjmccartney @EMARIANOMD I think expectations may also be different between parturients and other laparotomised patients.

@milliken_don @DrRobbieErskine @colinjmccartney @EMARIANOMD It is indeed. No doubt in the short term they are more comfortable, though!

@glauncel @DrRobbieErskine @colinjmccartney @EMARIANOMD Seems you can get around 20mg of spared parenteral morphine in 24h with <500mcg IT morphine. I have been impressed recently by its efficacy at low doses.

@milliken_don @DrRobbieErskine @colinjmccartney @EMARIANOMD The best literature on IT morphine is all alongside at least foundational analgesia, so that’s what I did. I am also quite heavy handed with steroids. I have been sadly underwhelmed by the literature in support of ketamine/dexmedetomidine/lidocaine on pain outcomes after PACU.

@glauncel @DrRobbieErskine @colinjmccartney @EMARIANOMD And yet IT a morphine 100-200mcg is universally provided for cesarean under spinal. Literature suggests that doses under 500mcg have similar rates of PONV and respiratory depression to PCA alone. Itchiness is the only noteworthy side effect.

@milliken_don @DrRobbieErskine @colinjmccartney @EMARIANOMD Which of course is made all the more shocking because it is UNIVERSAL in cesarean delivery in North America to use IT morphine. So one wonders why this is not more standard in other laparotomies.