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Minerva Anestesiologica 2002 November;68(11):833-47

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English, Italian

Ambulatory surgery with long acting regional anesthesia

Klein S. M., Buckenmaier C. C. III

Department of Anesthesiology Duke University Medical Center, Durham, NC, USA

Ambu­la­to­ry sur­gery has ­grown dra­mat­i­cal­ly in the ­past 3 ­decades; how­ev­er, advanc­es in post­op­er­a­tive ­pain treat­ment ­have not ­kept ­pace ­with the pro­life­ra­tion of out­pa­tient pro­ce­dures. Two tech­niques ­that may ­offer a solu­tion to ­part of ­this prob­lem are ­long act­ing periph­er­al ­nerve ­blocks (PNB) and out­pa­tient con­tin­u­ous periph­er­al ­nerve ­blocks (­CPNB), but the safe­ty of send­ing ­patients ­home ­with ­blocked extrem­ities has ­also ­remained con­tro­ver­sial. Unfor­tu­nate­ly, ­only a few ­large, pros­pec­tive stud­ies ­have exam­ined ­this ­issue direct­ly. ­Those ­that ­have ­addressed ­this par­tic­u­lar ques­tion sup­port the con­cept ­that region­al anes­the­sia and dis­charge ­with an insen­sate ­limb may be ­done safe­ly. Our ­group pros­pec­tive­ly stud­ied 2,382 ­long-act­ing PNB ­with ropiv­a­caine in ­both the ­upper and low­er extrem­ity not­ing a low inci­dence of ­block fail­ure, ­rare use of opi­oids in the recov­ery ­unit and ­high ­patient sat­is­fac­tion. ­This ­study ­also dem­on­strat­ed a low inci­dence of acci­den­tal inju­ry to the ­blocked extrem­ity and a ­rare ­block com­pli­ca­tion ­rate ­after dis­charge (0.2%). ­Only 1 ­patient in ­this ­data set ­fell ­while exit­ing a car. ­Patients in our ­study ­appeared to uni­form­ly pro­tect them­selves ­from fur­ther inju­ry ­despite hav­ing a ­blocked extrem­ity. In con­clu­sion, PNB and per­i­neu­ral cath­e­ter tech­niques are an excit­ing ­aspect of ambu­la­to­ry anes­the­sia and ­acute ­pain man­age­ment ­that has under­gone rap­id devel­op­ment in ­recent ­years. Suc­cess­ful appli­ca­tion of ­these tech­niques ­will ­require a sub­stan­tial edu­ca­tion­al invest­ment by anes­the­sio­lo­gists and anes­the­sio­lo­gists in train­ing. The ­rewards in ­reduced post­op­er­a­tive ­pain, ­improved ­patient sat­is­fac­tion, and anes­the­sio­lo­gist pro­fes­sion­al devel­op­ment ­make ­this endeav­or wor­thy of our atten­tion.