Use of Regional Anesthesia for Outpatient Surgery Within the United States: A Prevalence Study Using a Nationwide Database
- 1 June 2018
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Anesthesia & Analgesia
- Vol. 126 (6), 2078-2084
- https://doi.org/10.1213/ane.0000000000002503
Abstract
Regional anesthesia is of benefit for outpatient surgery given its demonstrated improvement in analgesia and decrease in complications, resulting in shorter average recovery room times and lower hospital readmission rates. Unfortunately, there are few epidemiological studies outlining the overall utilization of peripheral nerve blocks (PNBs) in this setting. Therefore, the primary objective of this study was to report the overall utilization of several types of PNBs among all candidate cases in the outpatient setting within the United States. We identified all cases from the National Anesthesia Clinical Outcomes Registry that were performed as an outpatient surgery. We reported the frequency of various types of PNBs among all candidate cases, defined as cases that potentially could have received a PNB. Changes in prevalence of PNB utilization from 2010 to 2015 were analyzed by using logistic regression. Of the 12,911,056 outpatient surgeries in the National Anesthesia Clinical Outcomes Registry, 3,297,372 (25.5%) were amenable to a PNB. However, the overall PNB frequency was only 3.3% of the possible cases. The overall utilization for PNB of the brachial plexus, sciatic nerve, and femoral nerve were 6.1%, 1.5%, and 1.9%, respectively. The surgical procedures generating the highest volume of PNBs were shoulder arthroscopies and anterior cruciate ligament reconstruction, in which 41% and 32% received a PNB, respectively. During this time period, there was a significant increase in overall PNB utilization for both single-injection and continuous PNB (P < .0001). However, the proportion of continuous PNB to single-injection PNB did not increase significantly. While the overall frequency of PNB is relatively low, there was a significant increase in its prevalence during the study period. Regional anesthesia offers significant positive impact for perioperative outcomes and hospital efficiency metrics; however, it is not clear what is limiting its widespread use. Future studies are necessary to identify barriers and disparities in care to implement methods to increase regional anesthesia volume nationwide where beneficial and appropriate.This publication has 12 references indexed in Scilit:
- Epidemiology, trends, and disparities in regional anaesthesia for orthopaedic surgeryBritish Journal of Anaesthesia, 2015
- Factors associated with hospital admission after rotator cuff repair: the role of peripheral nerve blockadeJournal of Clinical Anesthesia, 2015
- Making a DifferenceAnesthesia & Analgesia, 2015
- National Trends in Ambulatory Surgery for Upper Extremity Fractures: A 10-Year Analysis of the US National Survey of Ambulatory SurgeryHAND, 2014
- Peripheral nerve blocks for outpatient surgeryCurrent Opinion in Anaesthesiology, 2013
- Changes in Anesthesia-Related Factors in Ambulatory Knee and Shoulder SurgeryRegional Anesthesia & Pain Medicine, 2011
- The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee Recommendations for Education and Training in Ultrasound-Guided Regional AnesthesiaRegional Anesthesia & Pain Medicine, 2010
- Paravertebral Blocks Provide Superior Same-Day Recovery over General Anesthesia for Patients Undergoing Inguinal Hernia RepairAnesthesia & Analgesia, 2006
- Peripheral Nerve Blocks Result in Superior Recovery Profile Compared with General Anesthesia in Outpatient Knee ArthroscopyAnesthesia & Analgesia, 2005
- A Comparison of Infraclavicular Nerve Block versus General Anesthesia for Hand and Wrist Day-case SurgeriesAnesthesiology, 2004