Impact of a regional anesthesia analgesia program for outpatient foot surgery

Purpose: To examine the effects of a Regional Anesthesia and Analgesia (RAA) program for outpatient foot surgery in an outpatient unit. Methods: The RAA program was implemented in our Surgical Day Care Center (SDCC) in 1992-93. Fifty charts were randomly selected for each of two periods, 1990 (pre-program) and 1995 (post-program). One surgeon operated on all patients. Preoperative, intraoperative and postoperative information collected included demographic data, block type, analgesic requirements, nursing visits and complications. A time analysis of the perioperative course was also performed. Results: The use of regional block increased from 2% to 82% as a result of the RAA program. This was not accompanied by a change in operating room efficiency (anesthetic time, preparation time, exit time). Patient stay in the PACU and discharge lounge was reduced by a mean difference of 7 min (Upper 95% Cl = 24 min) and fentanyl consumption in the OR was reduced by 35 mu g (95% Cl = -8, -62 mu g), The number of patients who required > 1 < 4 nursing visits for analgesia administration in the PACU decreased from 17 to 9 after program implementation. Conclusions: Regional anesthesia is more likely to be offered to outpatients if it is introduced as a formal RAA program. Such a program did not have a negative impact on operating room efficiency and was beneficial in reducing patient stay in the PACU and discharge lounge. Facility discharge processes may need to be modified to obtain the maximum benefits from such RAA programs.