Regional anesthesia and ambulatory surgery

被引:25
作者
Moore, Jeffrey G. [1 ]
Ross, Scott M. [1 ]
Williams, Brian A. [1 ]
机构
[1] Univ Pittsburgh, Sch Med, Dept Anesthesiol, Pittsburgh, PA 15240 USA
基金
美国国家卫生研究院;
关键词
ambulatory anesthesia; healthcare economics; nerve block; postoperative nausea and vomiting; regional anesthesia; PERIPHERAL-NERVE BLOCKS; ABDOMINIS PLANE BLOCK; ELIMINATING POSTOPERATIVE NAUSEA; CRUCIATE LIGAMENT RECONSTRUCTION; THORACIC PARAVERTEBRAL BLOCK; MINIDOSE LIDOCAINE-FENTANYL; OUTPATIENT KNEE SURGERY; OFF-PATENT ANTIEMETICS; CARE-UNIT BYPASS; GENERAL-ANESTHESIA;
D O I
10.1097/ACO.0000000000000011
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Purpose of reviewAdvances in surgery and anesthesia have allowed for more surgeries to be done on an outpatient basis. A recent important advance entails availability of suitable recovery criteria to capitalize on the benefits of regional anesthesia for ambulatory surgery. With ever-escalating healthcare costs and expectations for faster recovery, anesthesiologists are now challenged to design anesthesia plans focused on Phase I postanesthesia care unit bypass and early facility discharge. Satisfying the recently published WAKE Score criteria upon operating room exit is associated with hospital cost reductions. This review highlights regional anesthesia techniques with focus on outpatient orthopedics. We also discuss multimodalities' addressing postoperative nausea and vomiting prophylaxis, perioperative analgesia (including perineural analgesia), and sedation-hypnosis, which are all central to timely recovery using now-available suitable recovery criteria.Recent findingsUltrasound-guided regional anesthesia has increased the comfort level for many anesthesiologists performing blocks. Other advances include better monitoring of anesthetic depth for titration of sedatives, en route to avoiding emetogenic and hyperalgesic volatile anesthetics.SummaryRoutine regional anesthesia use, multimodal postoperative nausea and vomiting prophylaxis, multimodal sedation-hypnosis, and multimodal analgesia, along with avoiding volatile agents and short-duration opioids, can lead to both routine Phase 1 postanesthesia care unit bypass and expedited same-day discharge, when using suitable recovery criteria.
引用
收藏
页码:652 / 660
页数:9
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