'This block lasts about eighteen hours' is heard as reassurance and forgotten. 'Your leg will start to hurt around four o'clock tomorrow morning, and you need to have taken the tablets before then' is heard as an instruction, and acted on.
Rebound pain is not a failure of the block; it is the block ending, and it ends predictably. So convert the duration into a clock time at the moment you site the block, tell the patient that time, and write it on the chart so the ward knows too. Then state what should be taken before it and by whom.
The same sentence should say what to do if the pain arrives early. A patient who has been told the expiry time and given a threshold to act on will take the paracetamol at 2 a.m.; a patient told a duration will wait to see whether it settles, and by then the oral regimen is three hours behind.
- Convert block duration to a clock time and say it aloud to the patient
- Write the expected expiry time on the anaesthetic chart and the ward drug chart
- Specify which analgesia is to be taken before that time, not when pain starts
- Give a threshold and an action for pain arriving earlier than expected
- Tell the ward nurse the same time - the patient should not be the only one who knows
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