Regional anesthesia at home

Abstract

Purpose of review To review the recently published peer-reviewed literature involving regional anesthesia and analgesia in patients at home. Recent findings The potential benefits and risks of regional anesthesia and analgesia at home are pertinent queries, and increased data regarding these topics are rapidly becoming available. Of particular interest is the use of continuous peripheral nerve blocks at home and their potential effect upon hospitalization duration and recovery profile. Summary Advantages of regional techniques include site-specific anesthesia and decreased postoperative opioid use. For shoulder surgeries, the interscalene block provides effective analgesia with minimal complications, whereas the impact and risks of intraarticular injections remain unclear. Perineural catheters are an analgesic option that offer improved pain relief among other benefits. They are now being used at home in both adult and pediatric populations.

Ambulatory continuous posterior lumbar plexus blocks following hip arthroscopy: a review of 213 cases

“…These included two patients with potential LAST, one patient with bilateral or epidural spread, one patient who fell, and 4 patients with severe neuropathies, resulting in an overall significant complication rate of 3.8%. All minor complications in this series were managed on an outpatient basis, and the rates of severe or persistent neurologic injury were similar to those previously reported for inpatient continuous lumbar plexus block and other types of ambulatory perineural infusions [17,18]. Two patients (0.9%) in this series had symptoms concerning for LAST.…”

Outpatient total shoulder arthroplasty: A cost-identification analysis

“…Similarly, PNB cost estimates were based on the previous literature, with ranges from $1752 to $5550 in total cost per patient. In our reference case, we estimated the cost of PNB $3556 based on similar reports by Cheng et al 38 , Horn et al 39 , and Williams et al 40 The proportion of those undergoing inpatient TSA managed with each of these pain regimens was also estimated. We could not identify prior studies in the literature upon which to draw when generating estimates about pain control.…”

Recent advances in the pharmaceutical management of pain

“…Postoperative analgesia is generally limited to 12-16 h or less after single-injection regional nerve blocks, but can be prolonged by using a local anesthetic infusion via a perineural catheter. This technique may now be used in the outpatient setting with the relatively recent introduction of reliable, portable infusion pumps [105]. This has resulted in faster and improved rehabilitation, better analgesia, greater patient satisfaction and reduced nausea and vomiting because of an opioid-sparing effect [106].…”