Effect of peripheral nerve blocks on postanesthesia care unit length of stay in patients undergoing ambulatory surgery: a retrospective cohort study

Abstract

BackgroundPeripheral regional anesthesia and analgesia may increase the efficiency of ambulatory surgical centers by reducing pain and preventing nausea and vomiting, which are important modifiable causes of prolonged postanesthesia care unit (PACU) length of stay. We hypothesized that the use of peripheral nerve blocks (PNB) was associated with shorter PACU length of stay in ambulatory surgery.MethodsIn this retrospective cohort study, we analyzed data from adult ambulatory surgical cases, in which PNB was a viable anesthetic option (ie, was routinely performed for these procedures), at an academic medical center between 2008 and 2018. We assessed the association between the use of PNB and the primary endpoint of PACU length of stay. As key secondary endpoint, we compared intraoperative opioid doses. Analyses were adjusted for patient demographics, comorbidities and intraoperative factors.ResultsA total of 57 040 cases were analyzed, of whom 13 648 (23.9%) received a PNB. The use of PNB was associated with shorter PACU length of stay (a decrease of 7.3 min, 95% CI 6.1 to 8.6, p<0.001). This association was most pronounced in surgeries of long duration (decrease of 11.2 min, 95% CI 9.0 to 13.4) and in patients undergoing leg and ankle procedures (decrease of 15.1 min, 95% CI 5.5 to 24.6). Intraoperative opioid doses were significantly lower in patients receiving a nerve block (decrease of 9.40 mg oral morphine equivalents, 95% CI 8.34 to 10.46, p<0.001).ConclusionThe use of PNB significantly reduced PACU length of stay in ambulatory surgical patients, which may in part be attributed to lower intraoperative opioid requirements.

Body Mass Index Is Not an Independent Factor Associated With Recovery Room Length of Stay for Patients Undergoing Outpatient Surgery

“…Important examples of these factors include our secondary findings: regional techniques contributed to shorter PACU recovery time and longer surgery duration contributed to longer recovery time. Our findings regarding regional anesthesia are consistent with similar studies in the ambulatory surgery setting, potentially due to lower intraoperative opioid requirements 14 . Such trends may prove beneficial in helping outpatient surgery teams produce protocols to maximize efficiency, maintain quality, and increase patient satisfaction.…”

“…Our findings regarding regional anesthesia are consistent with similar studies in the ambulatory surgery setting, potentially due to lower intraoperative opioid requirements. 14 Such trends may prove beneficial in helping outpatient surgery teams produce protocols to maximize efficiency, maintain quality, and increase patient satisfaction.…”

Delayed discharge from post-anesthesia care unit: A 20-case retrospective series

“…The use of peripheral nerve blocks significantly reduced PACU length of stay, which may in part be attributed to lower intraoperative opioid requirements. [ 14 ] However, in this study, 5 patients who underwent general anesthesia combined with peripheral nerve block developed delayed discharge from the PACU, which may be partly due to the residual effects of anesthetic agents. Moreover, the incidence of delayed awakening due to anesthesia was not high.…”

The effects of sugammadex vs. neostigmine on postoperative respiratory complications and advanced healthcare utilisation: a multicentre retrospective cohort study

“…ambulatory surgery, same‐day admission surgery or inpatient surgery); day vs. night surgery [20]; pre‐operative anaemia; respiratory tract infection during the 30 days before surgery; and home oxygen dependency were included as confounding factors. Analyses were further adjusted for intra‐operative and anaesthesia‐related factors, including: surgical speciality; regional or neuraxial anaesthesia [21]; emergency status; duration of surgery; intra‐operatively administered dose of short‐ and long‐acting opioids; vasopressors; non‐depolarising neuromuscular blocking drug dose; crystalloid and colloid infusions; age‐adjusted mean alveolar concentration of inhalational anaesthetics; minutes of mean arterial pressure <55 mmHg [22]; surgical complexity based on surgical work relative value units; number of packed red blood cell units administered intra‐operatively; and parameters related to ventilation such as the median respiratory rate [15], tidal volume, respiratory system compliance [17], fraction of inspired oxygen and positive end‐expiratory pressure. Potential trends over time and differences across the included healthcare networks were addressed through adjustment for the year of surgery and for the healthcare network in which the procedure was performed.…”