Comprehensive Analysis of 13,897 Consecutive Regional Anesthetics at an Ambulatory Surgery Center

• Published in: Pain medicine (Malden, Mass.) Vol. 19; no. 2; pp. 368 - 384
• Main Authors: Malchow, Randall J, Gupta, Rajnish K, Shi, Yaping, Shotwell, Matthew S, Jaeger, Lisa M, Bowens, Clifford
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.02.2018
• Subjects: Adolescent; Adult; Aged; Ambulatory care; Ambulatory Care Facilities; Ambulatory Surgical Procedures; Analgesia; Analysis; Anesthesia; Anesthesia, Conduction - adverse effects; Anesthesia, Conduction - methods; Anesthetics; Anesthetics, Local - adverse effects; Central nervous system agents; Central nervous system depressants; Child; Child, Preschool; Clonidine; Dexamethasone; Female; Glucocorticoids; Humans; Infant; Male; Medical research; Medical societies; Middle Aged; Nausea; Neurologic manifestations; Neurology; Obesity; Pain perception; Pain, Postoperative - epidemiology; Patient Satisfaction; Pons; Postoperative Nausea and Vomiting - epidemiology; Postoperative pain; Postoperative period; Professional associations; Risk factors; Ropivacaine; Sex; Surgery; Surgical clinics; Vomiting; Young Adult; Postoperative Pain; Regional Anesthesia; Postoperative Nausea and Vomiting; Ambulatory Surgery; Postoperative Neurological Symptoms; Patient Satisfaction
• ISSN: 1526-2375; 1526-4637
• DOI: 10.1093/pm/pnx045

Abstract Objective The authors investigated a wide range of perioperative outcome measures in the context of a robust regional anesthesia practice. Design Comprehensive review of a prospectively collected six-year database. Setting Freestanding, academic ambulatory surgery center. Subjects There were 13,897 consecutive regional anesthetics in 10,338 patients. Methods We investigated patient satisfaction, postoperative nausea and vomiting (PONV), postoperative pain, catheter analgesia, and complications. Clinical risk factors were examined and presented as odds ratios for multiple outcome analyses including block success, patient satisfaction, PONV, and postoperative neurologic symptoms (PONS). Results Decreased block success was associated with nerve stimulation alone (P < 0.001), obesity (P = 0.001), higher American Society of Anesthesiologists classification (ASA; P = 0.01), lower extremity blocks (P = 0.04), and male sex (P < 0.001). Decreased patient satisfaction was associated with poor catheter analgesia (P < 0.001), complications (P < 0.001), higher ASA (P = 0.001), and younger age (P = 0.008). PONV was associated with postoperative pain (P < 0.005), female sex (P < 0.001), general anesthesia (P < 0.001), younger age (P = 0.001), lack of catheter (P = 0.03), and lack of dexamethasone/clonidine (D + C) adjuncts (P = 0.01). Serious complications and unexpected hospitalizations were rare (<0.2%). D + C adjuncts, lower extremity blocks, clonidine (but not dexamethasone alone), and female sex were associated with PONS (all P < 0.001). Conclusions A regional anesthesia–based practice in ambulatory surgery is an effective means of providing excellent postoperative analgesia and is associated with a low rate of PONV and unexpected admissions. Dexamethasone, clonidine, and their combination when combined with 0.5% ropivacaine may have mixed effects on PONS risk that warrant dose/concentration alterations of these three drugs in the context of off-label perineural adjunct use.