On researching less demanding postop analgesia techniques, I came across the 5% lidocaine patch which I was familiar with from my pain management fellowship.  I could only find a few studies and only access one of those regarding its use.  The one I did access showed no decrease in postop morphine use but showed decrease in pain scores with coughing (when used after radical retropubic prostatectomy).  Many of the links referenced its use in cats and dogs.  Does anyone have any personal experience with its use for postop analgesia or know of any additional studies?

0.075% ropivacaine seems relatively well tolerated and provides adequate postop analgesia, especially if pt. is allowed a prn IV NSAID (eg. ketorolac)

At my institution we have ropivacaine 0.15% and 0.075% (both alongwith sufentanyl 2 mcg/ml) available to us.  Most of us including myself use the higher concentration for labor analgesia with good results although what you mentioned (very dense abdominal analgesia) certainly is the norm apart from some perineal pressure at delivery time presumably due to sacral sparing.

I have recently become interested in these as my group have decreased the number of epidurals we leave in because of anticoagulation, reimbursement, and followup issues.

I have done a handful with and without ultrasound guidance, with varying effectiveness.

Anybody have more experience with these?  Could you share some helpful pointers?

Most of the sources say that the goal is to inject between IO and TA, although some say that the nerves can penetrate IO laterally and lie between EO and IO.

I do not have access to blunt needles so the so-called "double pop" technique is not much of an option; instead when performing the block blind I use a 25 g 1.5 inch needle which I doubt reaches the TA plane in my obese patient population (TX, USA).

Any thoughts?

I have used the proseal LMA (one with gastric drain) for CEA in the past.  I found it allowed a quicker wake up than with ETT, hence earlier evaluation for neurologic deficits.  I stopped after some negative feedback from a surgeon and the rest of my group (I am significantly junior), but I still think it to be a useful technique.

Anyone with similar experience?

A topic which is near and dear to my heart,

I commonly use the flexible LMA for SHORT prone procedures (mostly kypho/vertebroplasty); I do not have experience inserting it in the prone position although I can see the utility of this (pt. can position themselves); I make sure I have a very good fit, can PPV, and tape it well.  I tend to avoid it in obese pt's (uncommon with osteoporosis). As far as aspiration, gravity should allow for external drainage.  As regards laryngospasm, I avoid desflurane and like to think if it occured, I could give some succ and PPV.

Welcome comments.

I agree more or less with jafo although I think that may even be excessive and would put most of the emphasis on phonation (classically saying EEEE); as a patient who is able to do that would have almost no chance of either recurrent laryngeal nerve palsy.