Very nice idea! But I haven't yet used it. If you have any experience you may please share it.

Patient complain of severe postop pain if analgesia not covered

I have used prilocaine as local anesthesant, based on immediate skin penetration cream and it effective locally in a reduced volume

I have had many years of experience in clinical anesthesiology practice using spinal analgesia for countless orthopedic surgeries, prostatectomies, cesarean sections, saddle blocks for labor and delivery, and so forth. My favorite was a young woman who feared general anesthesia and insisted on spinal analgesia (despite warning) for gynecological surgery despite the surgeon's plan to use laparoscopic surgery. She had obvious difficulty breathing due to the CO2 insufflation of her peritoneum, but never complained, and the outcome was excellent. I insisted on spinal analgesia for my recent inguinal hernia surgery despite the protest of the anesthesiologist, who believed that general anesthesia plus "multimodal analgesia" was better. Like the girl, I feared general anesthesia because I know that most practitioners dangerously hyperventilate patients and avoid effective doses of opioids that are necessary for optimal outcome. Spinal analgesia provides superior analgesia and protection against the surgical stress syndrome, and negates the notorious toxicity of multimodal analgesia, the harmful habit of hyperventilation, and the need for any other form of analgesia or sedation. He used marcaine, so recovery was a bit prolonged. I refused any form of sedation, slept through most of the procedure, enjoyed an excellent outcome, and went home early in the afternoon. I always recommend spinal analgesia when it is appropriate. It is superior to multiple block analgesia that has become a "fad" in recent years, because it is simple and reliable. With modern needles the risk of headache is moot.Unilateral spinal can be easily used for hip and knee procedures. However, for procedures where the airway might become inaccessible, I always employ elective intubation before the procedure begins. In fact, I believe that elective intubation to secure the airway should be used BEORE the spinal analgesic is installed, especially in cases of broken hip where positioning the patient is painful and problematic. This reduces stress for the patient, and enables ideal positioning for the purpose of installing the spinal analgesia. The risk of nerve damage is less than when spinal (or epidural) analgesia is installed when the patient is awake. I used epidural analgesia in preference to spinal for prolonged surgeries where the duration of spinal analgesia might not be adequate, but then always confirmed that the epidural was working before initiating general anesthesia, and I always added generous opioid dosage to assure adequate analgesia during the procedure. Analgesia is far more important than anesthesia for controlling surgical stress, and general endotracheal anesthesia is safer and more effective than intravenous sedation.

BTY I walked home after my hernia surgery and experienced no pain until the day after surgery, when the surgical mesh caused pain.

It's been known since the days of George Washington Crile more than 100 years ago that it's necessary to complement general anesthesia with effective analgesia for optimal surgical outcome, whether it be opioids or blocks. The use of multiple blocks is a bad idea, because if any one of them fails, then analgesia becomes inadequate. Crile preferred prilocaine infiltration to morphine, but that was in the day when needle technology was so inferior that intravenous access was impractical. Crile noted that care must be taken to block every nerve with the prilocaine lest inadequate analgesia result in problematic muscle tension. He must have been an awesome surgeon. He used successive doses of IM morphine when his prilocaine technique was inadequate, as in gigantic uterine tumors etc. but in his day this was time-consuming and less practical than prilocaine infiltration. Today we have superior medications, monitors, and machines but don't know how to use them properly.

We use low dose Bupivacaine itself for day care surgeries

Have no experience with prilocaine,commonly use marcaine and lignocaine