Before the Day of Surgery

• A member of our anesthesia team will attempt to call you at least one day before surgery to review your medical history and medications.
• Based on our preoperative review of your medical records, we may have you come in to perform further tests to minimize delays the day of surgery.
• We may also request that you make an appointment with one of your physicians if further information is needed to minimize your risk of anesthesia.

Personalized Anesthetic Plan

Based on the information you provide, your medical history, previous anesthetics, and planned procedure, we will come up with the safest personalized anesthetic plan that will allow for the quickest recovery to you. The plan may include one or a combination of the following types of anesthesia:

• Sedation- With this type of anesthesia, you will be given medicine to be relaxed while allowing you to wake up quickly after the procedure. This sedation can range from light sedation where you will feel sleepy and may or may not remember the procedure to heavy sedation such as for a colonoscopy where there is a high likelihood you will not remember the procedure yet no invasive airway device needs to be placed.
• Spinal- This type of anesthesia allows us to place a small amount of medicine into your back, safely away from the spinal cord, and numb up from your ribs down. Often the most uncomfortable part of this anesthetic technique is the numbing medicine placed under the skin which feels like an ant bite that quickly goes numb. The spinal medicine usually lasts about 3 hours and is appropriate for most lower body procedures.
• Epidural- Very similar to a spinal anesthetic except it allows us to place a catheter where we can infuse medicine for up to 48 hours of pain relief.
• Regional Block- Using specialized ultrasound equipment, we are able to find the nerves that supply the area where the surgeon will be operating. We then put numbing medicine around these nerves to take away about 50 to 100% of the surgical pain. This can either be done as a "single shot" which will provide 3 to 6 hours of pain relief or as a "continuous catheter" where medicine can be infused for up to three days.
• General Anesthesia- This anesthetic plan provides for complete unconsciousness. Medicine will be infused through your IV where you will drift off to sleep. Once you are asleep, a specialized airway device will be placed to help protect your airway. The airways device will be removed at the safest time possible and there is a high likelihood you may not recall having an airway device in.

Recovery Room to Discharge

• The next thing you may remember after drifting off to sleep is the recovery room. You will have one on one care from a specialized recovery room nurse who will watch your vitals signs, physically examine you, and ensure your safety after surgery.
• You will be watched for at least 15 minutes and a member from our anesthesia team will be immediately available in case there are concerns.
• Once you have met discharge criteria, you will either be taken up to the preoperative room or to the floor for admission.
• If you are taken to your preoperative room, a nurse will monitor your vital signs, monitor you for any safety concerns and ensure that you are appropriate to be discharged home.
• If you are taken to the floor, a nurse will assess you and explain the rest of the process.
• A member from our anesthesia team is always available, either in the facility or on call.
• Once you have met discharge criteria, you will be sent home with discharge instructions from the surgeon and other team members.

Getting Familiar With The Catheter and Pump

Your continuous block consists of:

1. A catheter that is inserted next to the nerve, up to 3 inches deep. It is not in a vessel. This part may not be visible to you.
2. A dressing over the catheter, this usually obscures where the catheter is inserted in the skin.
3. The remaining part of the catheter that has a hub at the end of it.
4. The medicine catheter that is connected to the hub.
5. A little white clamp that should be unclamped.
6. A dial set at a predetermined rate.
7. A medicine reservoir housed in a carrying case.

Troubleshooting Your Block

There is clear liquid leaking around the catheter...

Sometimes the nerve sits between muscles. Moving these muscles squeezes the medicine out around the catheter. As long as the dressing is intact and the hub is connected, the nerve is getting bathed in medicine and is working correctly. Reinforce the dressing with some gauze.

The hub became disconnected...

Keep the catheter and hub as clean as possible and call us.

I don't think my block is working...

Make sure that the dressing is intact, the hub is connected, the white clamp is open, the dial is not set to zero, and the reservoir is not empty. If everything looks correct and the pain is getting much worse, go ahead and call us. Please remember that the initial block is much stronger than the block you are going home with. This means that a few hours after surgery, you may feel an increase in pain but it should be bearable and easily controlled with pain medicine. The goal of the block is to take away 50% to 100% of the pain so you will still feel a little bit to half of the pain you would without the block.

The catheter came out!

It is very important to watch out for the catheter to prevent it from being pulled out unintentionally. If the catheter is out, unfortunately it will not be replaced. Clear liquid might leak out from the insertion site. Place a band-aid over it. The block will continue to work for 3 to 6 hours after it is pulled out. Notify our provider that the catheter came out during your daily checkup call that we make.

There is blood in the catheter...

Immediately clamp the catheter and turn the dial to zero. Call us.

I have ringing in my ears, a metallic taste in my mouth, and/or my vision is becoming blurry...

Immediately clamp the catheter and turn the dial to zero. Call us. If the symptoms are getting quickly worse, call 911 or have someone take you to the emergency room immediately.

Call Us

If you feel this is an emergency, call 911.

This phone number is only for anesthesia concerns related to continuous nerve blocks. For any other concerns, please call your surgeon's office and they will direct the call appropriately.

Phone: 1 (972) 932-7200

Ask to speak with anesthesia provider on call.

Please note: We do not refill pain medicine, give anesthesia quotes, or answer billing questions when calling this number.

Insurance Plans

All plans accepted by Texas Health Kaufman and the following insurance plans are "in network."

• Access Direct
• Aetna
• Amerigroup
• American Behavioral Benefits Manager
• Blue Cross Blue Shield
• Choice Care (Humana)
• Cigna
• Cigna Behavioral Health
• Cook Children's Health Plan (CCHP)
• First Care
• First Health / Coventry
• Galaxy Health Network
• Multiplan (includes BeechStreet)
• HealthSmart
• Great West HealthCare (Now Part of Cigna Agreement)
• UnitedHealthcare Benefits Inc (formerly PacifiCare)
• Parkland Comm Health Plan
• PHCS
• UnitedHealthcare Medicare Solutions (formerly Secure Horizons)
• Union Pacific Railroad Empl
• UnitedHealthcare
• United Behavioral Health
• USA Managed Care
• Humana Military Health (TriCare)
• Value Options
• HealthSpring
• Care N'Care
• Molina
• Superior Healthplan