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General Considerations for Regional Anesthesia Practice

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Essentials of Regional Anesthesia

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Abstract

Setting up a regional anesthesia service requires a reliable and consistent product as well as a sound business plan. Technological advances in nerve stimulation, ­ultrasound guidance, and perineural catheters have led to rapid growth in the number and types of peripheral nerve block procedures available to regional anesthesia practitioners. Starting a new regional anesthesia program potentially adds monetary value to a facility’s perioperative services by improving the quality of postoperative analgesia and recovery from surgery, thereby reducing perioperative costs and offering a competitive advantage over other surgical facilities. From the patient’s perspective, a regional anesthesia program provides nonmonetary value by preventing pain and reducing the risk of nausea and vomiting after surgery. Unfortunately for anesthesiologists interested in starting a new regional anesthesia program, there are no evidence-based guidelines to follow.

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References

  1. Ilfeld BM, Gearen PF, Enneking FK, Berry LF, Spadoni EH, George SZ, et al. Total knee arthroplasty as an overnight-stay procedure using continuous femoral nerve blocks at home: a prospective feasibility study. Anesth Analg. 2006;102:87–90.

    Article  PubMed  Google Scholar 

  2. Ilfeld BM, Gearen PF, Enneking FK, Berry LF, Spadoni EH, George SZ, et al. Total hip arthroplasty as an overnight-stay procedure using an ambulatory continuous psoas compartment nerve block: a prospective feasibility study. Reg Anesth Pain Med. 2006;31:113–8.

    PubMed  Google Scholar 

  3. Ilfeld BM, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, et al. Ambulatory continuous interscalene nerve blocks decrease the time to discharge readiness after total shoulder arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology. 2006;105:999–1007.

    Article  PubMed  Google Scholar 

  4. Chung F, Mezei G. Factors contributing to a prolonged stay after ambulatory surgery. Anesth Analg. 1999;89:1352–9.

    PubMed  CAS  Google Scholar 

  5. Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J, et al. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology. 2005;102:1001–7.

    Article  PubMed  CAS  Google Scholar 

  6. Hadzic A, Karaca PE, Hobeika P, Unis G, Dermksian J, Yufa M, et al. Peripheral nerve blocks result in superior recovery profile compared with general anesthesia in outpatient knee arthroscopy. Anesth Analg. 2005;100:976–81.

    Article  PubMed  CAS  Google Scholar 

  7. Hadzic A, Arliss J, Kerimoglu B, Karaca PE, Yufa M, Claudio RE, et al. A comparison of infraclavicular nerve block versus general anesthesia for hand and wrist day-case surgeries. Anesthesiology. 2004;101:127–32.

    Article  PubMed  Google Scholar 

  8. Macario A, Weinger M, Carney S, Kim A. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89:652–8.

    PubMed  CAS  Google Scholar 

  9. Klein SM, Nielsen KC, Greengrass RA, Warner DS, Martin A, Steele SM. Ambulatory discharge after long-acting peripheral nerve blockade: 2382 blocks with ropivacaine. Anesth Analg. 2002;94:65–70,table of contents.

    PubMed  Google Scholar 

  10. Jamieson BD, Mariano ER. Thoracic and lumbar paravertebral blocks for outpatient lithotripsy. J Clin Anesth. 2007;19:149–51.

    Article  PubMed  Google Scholar 

  11. Mariano ER, Watson D, Loland VJ, Chu LF, Cheng GS, Mehta SH, et al. Bilateral infraorbital nerve blocks decrease postoperative pain but do not reduce time to discharge following outpatient nasal surgery. Can J Anaesth. 2009;56(8):584–9.

    Article  PubMed  Google Scholar 

  12. Klein SM, Bergh A, Steele SM, Georgiade GS, Greengrass RA. Thoracic paravertebral block for breast surgery. Anesth Analg. 2000;90:1402–5.

    Article  PubMed  CAS  Google Scholar 

  13. Grant SA, Nielsen KC, Greengrass RA, Steele SM, Klein SM. Continuous peripheral nerve block for ambulatory surgery. Reg Anesth Pain Med. 2001;26:209–14.

    PubMed  CAS  Google Scholar 

  14. Nielsen KC, Greengrass RA, Pietrobon R, Klein SM, Steele SM. Continuous interscalene brachial plexus blockade provides good analgesia at home after major shoulder surgery-report of four cases. Can J Anaesth. 2003;50:57–61.

    Article  PubMed  Google Scholar 

  15. White PF, Issioui T, Skrivanek GD, Early JS, Wakefield C. The use of a continuous popliteal sciatic nerve block after surgery involving the foot and ankle: does it improve the quality of recovery? Anesth Analg. 2003;97:1303–9.

    Article  PubMed  Google Scholar 

  16. Bryan NA, Swenson JD, Greis PE, Burks RT. Indwelling interscalene catheter use in an outpatient setting for shoulder surgery: technique, efficacy, and complications. J Shoulder Elbow Surg. 2007;16:388–95.

    Article  PubMed  Google Scholar 

  17. Swenson JD, Bay N, Loose E, Bankhead B, Davis J, Beals TC, et al. Outpatient management of continuous peripheral nerve catheters placed using ultrasound guidance: an experience in 620 patients. Anesth Analg. 2006;103:1436–43.

    Article  PubMed  Google Scholar 

  18. Ilfeld BM, Morey TE, Wright TW, Chidgey LK, Enneking FK. Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesth Analg. 2003;96:1089–95,table of contents.

    Article  PubMed  Google Scholar 

  19. Ilfeld BM, Morey TE, Enneking FK. Continuous infraclavicular brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesthesiology. 2002;96:1297–304.

    Article  PubMed  CAS  Google Scholar 

  20. Ilfeld BM, Morey TE, Wang RD, Enneking FK. Continuous popliteal sciatic nerve block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study. Anesthesiology. 2002;97:959–65.

    Article  PubMed  CAS  Google Scholar 

  21. Mariano ER, Afra R, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, et al. Continuous interscalene brachial plexus block via an ultrasound-guided posterior approach: a randomized, triple-masked, placebo-controlled study. Anesth Analg. 2009;108:1688–94.

    Article  PubMed  CAS  Google Scholar 

  22. Ilfeld BM, Wright TW, Enneking FK, Vandenborne K. Total elbow arthroplasty as an outpatient procedure using a continuous infraclavicular nerve block at home: a prospective case report. Reg Anesth Pain Med. 2006;31:172–6.

    PubMed  Google Scholar 

  23. Ilfeld BM, Wright TW, Enneking FK, Mace JA, Shuster JJ, Spadoni EH, et al. Total shoulder arthroplasty as an outpatient procedure using ambulatory perineural local anesthetic infusion: a pilot feasibility study. Anesth Analg. 2005;101:1319–22.

    Article  PubMed  Google Scholar 

  24. Oldman M, McCartney CJ, Leung A, Rawson R, Perlas A, Gadsden J, et al. A survey of orthopedic surgeons’ attitudes and knowledge regarding regional anesthesia. Anesth Analg. 2004;98:1486–90,table of contents.

    Article  PubMed  Google Scholar 

  25. Mariano ER, Chu LF, Peinado CR, Mazzei WJ. Anesthesia-controlled time and turnover time for ambulatory upper extremity surgery performed with regional versus general anesthesia. J Clin Anesth. 2009;21:253–7.

    Article  PubMed  Google Scholar 

  26. Macario A, Vitez TS, Dunn B, McDonald T. Where are the costs in perioperative care? Analysis of hospital costs and charges for inpatient surgical care. Anesthesiology. 1995;83:1138–44.

    Article  PubMed  CAS  Google Scholar 

  27. Williams BA, Kentor ML, Vogt MT, Vogt WB, Coley KC, Williams JP, et al. Economics of nerve block pain management after anterior cruciate ligament reconstruction: potential hospital cost savings via associated postanesthesia care unit bypass and same-day discharge. Anesthesiology. 2004;100:697–706.

    Article  PubMed  Google Scholar 

  28. Dexter F, Macario A, Manberg PJ, Lubarsky DA. Computer simulation to determine how rapid anesthetic recovery protocols to decrease the time for emergence or increase the phase I postanesthesia care unit bypass rate affect staffing of an ambulatory surgery center. Anesth Analg. 1999;88:1053–63.

    PubMed  CAS  Google Scholar 

  29. Ilfeld BM, Mariano ER, Williams BA, Woodard JN, Macario A. Hospitalization costs of total knee arthroplasty with a continuous femoral nerve block provided only in the hospital versus on an ambulatory basis: a retrospective, case-control, cost-minimization analysis. Reg Anesth Pain Med. 2007;32:46–54.

    PubMed  Google Scholar 

  30. Kurtz S, Mowat F, Ong K, Chan N, Lau E, Halpern M. Prevalence of primary and revision total hip and knee arthroplasty in the United States from 1990 through 2002. J Bone Joint Surg Am. 2005;87:1487–97.

    Article  PubMed  Google Scholar 

  31. Greger J, Williams BA. Billing for outpatient regional anesthesia services in the United States. Int Anesthesiol Clin. 2005;43:33–41.

    Article  PubMed  Google Scholar 

  32. Gerancher JC, Viscusi ER, Liguori GA, McCartney CJ, Williams BA, Ilfeld BM, et al. Development of a standardized peripheral nerve block procedure note form. Reg Anesth Pain Med. 2005;30:67–71.

    PubMed  CAS  Google Scholar 

  33. Mariano ER. Making it work: setting up a regional anesthesia program that provides value. Anesthesiol Clin. 2008;26:681–92,vi.

    Article  PubMed  Google Scholar 

  34. Hebl JR, Kopp SL, Ali MH, Horlocker TT, Dilger JA, Lennon RL, et al. A comprehensive anesthesia protocol that emphasizes peripheral nerve blockade for total knee and total hip arthroplasty. J Bone Joint Surg Am. 2005;87 Suppl 2:63–70.

    Article  PubMed  Google Scholar 

  35. Armstrong KP, Cherry RA. Brachial plexus anesthesia compared to general anesthesia when a block room is available. Can J Anaesth. 2004;51:41–4.

    Article  PubMed  Google Scholar 

  36. Drolet P, Girard M. Regional anesthesia, block room and efficiency: putting things in perspective. Can J Anaesth. 2004;51:1–5.

    Article  PubMed  Google Scholar 

  37. Mariano ER, Cheng GS, Choy LP, Loland VJ, Bellars RH, Sandhu NS, et al. Electrical stimulation versus ultrasound guidance for popliteal-sciatic perineural catheter insertion: a randomized controlled trial. Reg Anesth Pain Med. 2009;34:480–5.

    Article  PubMed  Google Scholar 

  38. Mariano ER, Loland VJ, Bellars RH, Sandhu NS, Bishop ML, Abrams RA, et al. Ultrasound guidance versus electrical stimulation for infraclavicular brachial plexus perineural catheter insertion. J Ultrasound Med. 2009;28:1211–8.

    PubMed  Google Scholar 

  39. Mariano ER, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Afra R, et al. Ultrasound guidance versus electrical stimulation for femoral perineural catheter insertion. J Ultrasound Med. 2009;28:1453–60.

    PubMed  Google Scholar 

  40. Mariano ER, Loland VJ, Sandhu NS, Bellars RH, Bishop ML, Meunier MJ, et al. A trainee-based randomized comparison of stimulating interscalene perineural catheters with a new technique using ultrasound guidance alone. J Ultrasound Med. 2010;29:329–36.

    PubMed  Google Scholar 

  41. Sites BD, Chan VW, Neal JM, Weller R, Grau T, Koscielniak-Nielsen ZJ, et al. 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 anesthesia. Reg Anesth Pain Med. 2009;34:40–6.

    Article  PubMed  Google Scholar 

  42. Sites BD, Gallagher JD, Cravero J, Lundberg J, Blike G. The learning curve associated with a simulated ultrasound-guided interventional task by inexperienced anesthesia residents. Reg Anesth Pain Med. 2004;29:544–8.

    PubMed  Google Scholar 

  43. Hadzic A, Vloka JD, Kuroda MM, Koorn R, Birnbach DJ. The practice of peripheral nerve blocks in the United States: a national survey [p2e comments]. Reg Anesth Pain Med. 1998;23:241–6.

    Article  PubMed  CAS  Google Scholar 

  44. Smith MP, Sprung J, Zura A, Mascha E, Tetzlaff JE. A survey of exposure to regional anesthesia techniques in American anesthesia residency training programs. Reg Anesth Pain Med. 1999;24:11–6.

    PubMed  CAS  Google Scholar 

  45. Richman JM, Stearns JD, Rowlingson AJ, Wu CL, McFarland EG. The introduction of a regional anesthesia rotation: effect on resident education and operating room efficiency. J Clin Anesth. 2006;18:240–1.

    Article  PubMed  Google Scholar 

  46. Martin G, Lineberger CK, MacLeod DB, El-Moalem HE, Breslin DS, Hardman D, et al. A new teaching model for resident training in regional anesthesia. Anesth Analg. 2002;95:1423–7, table of contents.

    Article  PubMed  Google Scholar 

  47. Ilfeld BM, Esener DE, Morey TE, Enneking FK. Ambulatory perineural infusion: the patients’ perspective. Reg Anesth Pain Med. 2003;28:418–23.

    PubMed  Google Scholar 

  48. Ilfeld BM, Enneking FK. Continuous peripheral nerve blocks at home: a review. Anesth Analg. 2005;100:1822–33.

    Article  PubMed  Google Scholar 

  49. Ninger LJ, Patterson P. Regional anesthesia has strong outcomes for care, efficiencies. OR Manager. 2004;20(1):9–12.

    Google Scholar 

  50. Williams BA, DeRiso BM, Engel LB, Figallo CM, Anders JW, Sproul KA, et al. Benchmarking the perioperative process: II. Introducing anesthesia clinical pathways to improve processes and outcomes and to reduce nursing labor intensity in ambulatory orthopedic surgery. J Clin Anesth. 1998;10:561–9.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Financial Support. Dr. Mariano is supported by the University of California, San Diego Department of Anesthesia. The contents of this chapter are solely the responsibility of the author and do not necessarily represent the official views of this entity.

Conflicts of Interest.Dr. Mariano conducts regional anesthesia workshops for Stryker Instruments and I-Flow Corporation. He has also received material research support from Stryker, Sorenson Medical, Arrow International, and B Braun. These companies have had no input into any aspect of this manuscript.

Author information

Authors and Affiliations

  1. Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

    Edward R. Mariano MD, MAS

  2. Department of Anesthesiology, Stanford University School of Medicine, 3801 Miranda Avenue, 1112A, Palo Alto, CA, 94304, USA

    Edward R. Mariano MD, MAS

  3. Pediatric Perioperative Services, Lucille Packard Children’s Hospital, 725 Welch Road, Palo Alto, CA, 94304, USA

    Karley J. Mariano RN, BSN

Authors
  1. Edward R. Mariano MD, MAS
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Correspondence to Edward R. Mariano MD, MAS .

Editor information

Editors and Affiliations

  1. University Hosp and Ochsner Kenner Hosp, Prof and Chairman,Dept of Anesthesiology, Director of Interventional Pain Mgmt., Louisiana State University School of Medicine, New Orleans, 70112, USA

    Alan David Kaye

  2. Harvard Medical School, Director, Proced Sedation Mgmt & Safety, Assistant Professor of Anesthesia, Anesthesiology, Perioperative & Pain Med, Boston, 02115, USA

    Richard D. Urman

  3. Yale University School of Medicine, Associate Professor of Anesthesiology, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

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Mariano, E.R., Mariano, K.J. (2012). General Considerations for Regional Anesthesia Practice. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-1013-3_1

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  • DOI: https://doi.org/10.1007/978-1-4614-1013-3_1

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