In Reply To:
.that is if a busy OR can support this type of anesthetic.
This is probably the real reason spinals/epidurals are not offered very often. The average anesthesiologist is not very good at them, so they take "forever" to perform and they are not done "gently". I did a lot of them as a result of being a pain doc and was extremely good/fast. When asked to do a labor epidural my goal, which I met about 98% of the time was to have the catheter in and pain relief started within one contraction after turning the lady on her side, so less than 2-3 minutes. I never ever asked the patient to fold into a ball, never required any nursing assistance, or anything else to slow things down. For the ladies I also did the blocks at a higher level (T12-L1) than most (L4-5) so the pain relief would start sooner with less injected volume. Most docs are still painting on the betadyne in that time, let alone having the patient draped or starting the procedure.
In the OR I could have the catheter in and the prep started in essentially the same time as anyone else doing a general anesthetic.
People do a lot of unnecessary stuff when doing these and I think it is because it doesn't feel "natural" to them so they want to be extra careful and they think about every step. We had a neurosurgeon who was like that, whatever case he was doing he took three times as long to do anything as anyone else. Seemed like he was being careful but he had a complication rate like nobody else I have ever seen.
So, people don't offer stuff they are not comfortable with and they never get comfortable with it because they don't do it often enough.
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Frank,
An original Ironman and the Inventor of PowerCranks