The predictable failure after a single-shot block is not the block. It is the handover of a patient who is comfortable now and will not be at three in the morning, to a team who were not in theatre and have no way of knowing when the local anaesthetic will wear off.
So write a time, not a drug. 'Paravertebral block, 0.375% ropivacaine with esketamine, expect regression from about 02:00 — start regular paracetamol and the NSAID now, have the rescue dose prescribed and available.' That sentence does more for the night than anything in the anaesthetic record.
It also fixes the second failure: multimodal analgesia prescribed as required, and therefore never given, because the patient was comfortable at the drug round.
- State an expected time of block regression, not just the block performed.
- Prescribe background analgesia as regular, not as required, while the block is working.
- Make sure the rescue opioid is prescribed and on the ward before the block wears off.
- Tell the patient the block will wear off and what to ask for when it does.
- Hand this over verbally to the night team where the regression falls after handover.
Why it matters
The commonest cause of severe pain after a successful block is that nobody planned for it ending.
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