Continuous Versus Single-Injection Peripheral Nerve Blocks: A Prospective Cohort Study Comparing Procedural Time and Estimated Personnel Cost

Abstract

Background and Objectives: Continuous peripheral nerve blocks (CPNB) provide many additional benefits compared to single-injection peripheral nerve blocks (SPNB). However, the time and costs associated with CPNB provision have not been previously considered. The objective of this study was to compare the time required and estimated personnel costs associated with CPNB and SPNB. Methods: This IRB-exempt observational study involved provision of preoperative regional anesthesia procedures in a “block room” model by a dedicated team during routine clinical care. The primary outcome, the time to perform ultrasound-guided popliteal-sciatic blocks, was recorded prospectively. This time measurement was broken down into individual tasks: time to place monitors, prepare the equipment, scan and identify the target, perform the block, and clean up post-procedure. For peripheral nerve block catheters, time to insert, locate, and secure the catheter was also recorded. Cost estimates for physician time were determined using published national mean hourly wages. Results: Time measurements were recorded for 24 nerve block procedures (12 CPNB and 12 SPNB). The median (IQR; range) total time (seconds) taken to perform blocks was 1132 (1083-1290; 1060-1623) for CPNB versus 505 (409-589; 368-635) for SPNB (Table 1; p<0.001). The median (IQR) cost attributed to physician time during block performance was $35.20 ($33.66-$40.11) and $15.69 ($12.73-$18.32) for CPNB and SPNB, respectively. Conclusion: CPNB requires approximately 10 more minutes per procedure to perform when compared to SPNB. This additional time should be considered along with potential patient benefits and available resources when developing a regional anesthesia and acute pain medicine service.

Peripheral Nerve Blockade with Combined Standard and Liposomal Bupivacaine in Major Lower‐Extremity Amputation

“…When comparing PNB with a combination of standard and liposomal bupivacaine to PNB with standard bupivacaine alone, potential benefits are largely related to the avoidance of peripheral nerve catheter placement: enhanced patient comfort, reduced infection risk, ease of single-injection, and potential reduction in costs of care due to decreased resource utilization and time requirements for catheter placement and maintenance. 25 These same potential benefits would also be relevant compared with surgically placed perineural catheters, which have also been shown to reduce postoperative opioid consumption. 26 However, the long-term safety of liposomal bupivacaine in PNB has not been established.…”

Intra-articular Morphine and Ropivacaine Injection Provides Efficacious Analgesia As Compared With Femoral Nerve Block in the First 24 Hours After ACL Reconstruction: Results From a Bone–Patellar Tendon–Bone Graft in an Adolescent Population

“… 4 , 19 Additionally, a recent analysis showed that a single-shot peripheral nerve block takes a mean 505 seconds to complete when performed by an experienced regional anesthesia specialist. 2 This does not account for the additional time required for patient preparation, supply preparation, and additional delays in the setting of less experienced practitioners. Additionally, a cost analysis of peripheral nerve block and intra-articular injection revealed patient savings of 2.63% in those receiving intra-articular injection; a separate study showed a cost savings of $400.…”

Relative Contribution of Adjuvants to Local Anesthetic for Prolonging the Duration of Peripheral Nerve Blocks in Rats

“…Continuous perineural infusion can maintain analgesia for days but is met with challenges such as technical expertise, maintaining the catheter, and greater cost than a single injection. 4 One of the proposed solutions to extending the duration of long-acting local anesthetic is the addition of different classes of analgesics with the local anesthetic. Clonidine is one example that has been shown to prolong the duration of analgesia.…”