unfortunately, the statistics are very grim for physicians who abuse the drugs that are used in practice.  Many times, a physician is caught, sent to rehab and allowed to return to the same practice.  The first sign of relapse is finding the anesthesiologist dead from an accidental drug overdose.

I am sad to say that I recommend that you change to a different specialty.

I have done this several times and find it to be very helpful.  Often, I had very elderly people come in with broken hips and would give about 20mg of ketamine to help them through the pain of lying on their broken hip for the placement of the SAB.  I, too, let the LA drip very slowly.  We would wait about 5-10 minutes and then move the pt to the OR table.  I did see some spread to the contralateral side, but not much.  Waiting for 30 minutes is not really an option for me either.   But I do see a difference in the hemodynamic control in these frail, easily compromised elderly people.

I have started doing some fascia iliaca blocks and am thus far very pleased with the results.  Quick, low-risk as previously described, require no nerve stimulator, very comfortable for the patient.  I have done both single-shot with as much as 40cc of LA and can place catheters at one hospital at which I have privileges.  I did one 4 days ago for post op pain control for a patient having a BKA.  I really thought I would not get adequate analgesia because of a lack of effect on the sciatic nerve, but apparently, the 40cc volume tracked retrograde enough that his pain control was complete for about 6 hrs (no catheter allowed in this case.).  I have provided them for Total knee replacements, also.

Very recently introduced into my practice.  I am still learning a bit more about these;  my pet peeve so far is that the perfusionist tells me that the reading can be influenced by patient's skin tone, but does not put the sensor on until after general anesthesia has been induced.  So is that lower-that-expected reading because I am not controlling hemodynamics to provide adequate perfusion or is the darker skin tone altering the readings?  Seems to me that he should put the sensor on before significant sedation is given in order to see what the baseline reading is, esp on my patients with darker skin tones.  Need to do this next time.