Why Regional Anesthesia?
There are many benefits outside the risks and side effects of General Anesthesia and opioids:
- Pain can be eliminated during and after surgery
- Postoperatively, this pain control can be extended for many hours or days, with use of an epidural or continuous catheter that is placed next to a nerve with infusion of local anesthetic.
- With opioids being avoided, it prevents their side effects such as nausea, vomiting, and drowsiness coming into play
- The lack of pain and reduction of side effects from the opioids can result in a shorter stay in the recovery room and decreases the chance of an unplanned admission to the hospital
Regional Anesthesia (RA) and peripheral nerve blocks (PNBs) improve patient outcomes. RA and multimodal analgesia have revolutionized pain management to reduce dependency on opioids and gas anesthesia.
Advocating for the Patient with RA
- Pain can be eliminated during and after surgery.1
- Ease postoperative nausea and vomiting (PONV,) which is the one major side effect patients want to avoid after surgery.2
- Reduce incidence of respiratory depression, which is caused by the dependence on opioids for post op pain control.3
- Decrease somnolence, as patients benefit from improved sleep patterns. RA can be used to reduce surgical stress and provide superior analgesia with fewer opioids.4
- Prevent pulmonary embolism (PE) and thromboembolic complications.5
- Decrease ileus (lack of movement somewhere in the intestines) that leads to a buildup and potential blockage of food material.6
- Improve functional outcomes, because patients recover more effectively when they are engaged in their own rehabilitation.7
- Optimal analgesia allows patients to achieve early mobilization, improves physical therapy participation, and provides better functional results. Furthermore, RA may facilitate an earlier return to work, potentially generating cost savings for the patient.8
The Use of RA by Healthcare Facilities
- Improved patient satisfaction scores can positively impact HCAHPS scores and facility marketability.9
- Increased Operating Room utilization and efficiency can decreases non-surgical time to maximize the efficiency and number of cases.2
- Eliminated or reduced post-anesthesia care unit (PACU) time can significantly boost profitability.10
- Decreased length of stay has positive far-reaching implications for both patient and provider.11
- Fewer admissions and readmissions can reduce unplanned events helping minimize unnecessary costs and improving the bottom line.12
1 Liu SS. Strodtbeck WM, Richman JM. Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: A meta-analysis of randomized control trials. Anesth Analg. 2005 Dec;101(6):1634-42.
2 Williams BA, Motolenich P, Kenter ML. Hospital Facilities and Resource Management: Economic Impact of a High-Volume Regional Anesthesia Program for Outpatients. Int Anesthesiol Clin. 2005 Summer; 43(3):43-51.
3 Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321:1493-1497.
4 Ilfeld BM, Morey TE, Wang RD, et al. Continuous popliteal sciatic nerve block for postoperative pain control at home: a randomized, double-blinded, placebo controlled study. Anesthesiology. 2002;97:959-965.
5 Kehlet H, Wilmore DW. Multimodal strategies to improve the surgical outcome. AM J Surg. 2002;183:630-641.
6 Ahn H, Bronge A, Johansson K, Ygge H, Lindhagen J. Effect of continuous post operative analgesia on intestinal motility. Br J Surg 1988; 75: 1176-8.
7 Cohen NP, Levine WN, Marra G, et al. Indwelling interscalene catheter anesthesia in the surgical management of stiff shoulder: a report of 100 consecutive cases. J Shoulder Elbow Surgery. 2000;9:268-274
8 Nielsen et al. Outcomes after RA. Int Anesthesiol Clin. 2005 Summer; 43(3):96.
9 Wu CL, Naqibuddin M, Fleisher LA. Measurement of Patient satisfaction as an outcome of regional anesthesia and analgesia: a systematic review. Reg Anesth Pain Med. 2001;26:196-208.
10 Hadzic A, Arliss J, Kerimoglu B, et al. A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. Anesthesiology. 2004; 101:127-132.
11 David Nelson. The Impact of Regional Anesthesia on Perioperative Outcomes. 2011.
12 Mark Dalton. M.D. Orthopedic Foot and Ankle.