Hi there, four eyes ::

From what I understand, having been in line to have a hernia repaired before other potential complications developed, surgery on the extremities is much riskier than the torso. That said, my pain mgt. doc recommended that I nevertheless have the hernia repair done with a continuous nerve block or possible an epidural in the event that the surgeon was absolutely certain that the procedure would be over before the two-hour window of the epidural expired.

The hard part is that without a two hour guarantee, the patient needs to arrange a pre-op conference with the anesthesiologist. These are important for two reason, first to make sure that the anesthesiologist is on board with the continuous block and, secondly, to insure that the anesthesiologist - who is otherwise assigned to the case the day before - doesn't walk into the O.R., look at the list of the various pain meds the patient is on, declare that s/he can’t predict what the interactions with the anesthesia will be and storm out of the room, thereby cancelling the surgery for the day. (My internist is personally aware of situations where this has happened.)

And at least in Los Angeles, I'm advised community/private hospitals simply don't have any arrangement for such consultations: anesthesiologists are assigned to cases the day before the procedure, end of story. Even what is often regarded as the top (and certainly largest) private hospital, Cedars Sinai Medical Center doesn't do anesthetic pre-op conferences, which is available at only two hospitals in all of LA: USC and UCLA.

Bottom line: if anesthesia practice in Los Angeles is anything like that in your area, surgery on RSD/CRPS patients may be best left to university/medical school hospitals. And besides, they are far more liberal when it comes to having insurance cover the total cost of the hospitalization, especially for the time of the physicians and surgeons, than are most non-profit hospitals, where the physician makes a profit even if the hospital does not.

I hope this is helpful.

Mike