Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewOutcome after regional anaesthesia in the ambulatory setting--is it really worth it?
Regional anaesthesia provides a continuum of perioperative care that includes perioperative pain management, decreased opioid requirements and decreased post-operative nausea and vomiting. In addition to these benefits, a wide variety of perioperative outcomes can be enhanced by utilizing regional anaesthesia in the ambulatory setting. ⋯ In addition, regional anaesthesia can facilitate early recovery with excellent post-operative analgesia and few side-effects, which may decrease overall operative costs. This chapter identifies important perioperative outcomes that may be positively influenced by the use of regional anaesthesia in the ambulatory setting.
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The majority of upper extremity surgeries are performed on an ambulatory basis under intravenous regional anaesthesia or brachial plexus blockade. The former technique is easy to perform, has a rapid onset and a high success rate but provides limited post-operative analgesia. Brachial plexus blockade provides excellent intraoperative anaesthesia as well as post-operative analgesia, eliminates the need for post-operative opioids, resulting in a decrease in recovery time, shortened hospital stay, increased patient satisfaction and ultimately a decrease in perioperative costs when compared with general anaesthesia. This chapter reviews upper extremity surgical procedures performed below the shoulder, the anaesthetic options available, and techniques used to optimize post-operative pain control.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewParavertebral anaesthesia/analgesia for ambulatory surgery.
For many years, paravertebral nerve blockade has been an established technique for providing analgesia to the chest and abdomen. The current emphasis on containment of health care costs has resulted in a rediscovery of anaesthetic techniques, such as paravertebral blocks, that facilitate outpatient surgical management and promote early discharge. ⋯ Continuous paravertebral catheters, pharmacological agents used in PVB, and single versus multiple injection paravertebral block techniques are also covered. Specific clinical situations that are particularly well suited to the application of PVB as the primary anaesthetic in the ambulatory setting and other clinical situations where analgesia from PVB is efficacious are discussed.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewSingle-injection applications for foot and ankle surgery.
Foot or ankle surgery is often performed in an ambulatory care setting. The post-operative pain that follows can be moderate to severe in intensity and difficult to control with oral analgesics. Regional anaesthetic techniques have been advocated for such procedures. ⋯ Patients can be safely discharged even when long-acting local anaesthetics are used. In major surgery a continuous technique can be proposed. When the prone position is impossible the lateral approach is an efficient alternative.
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Best Pract Res Clin Anaesthesiol · Jun 2002
ReviewMaking an ambulatory surgery centre suitable for regional anaesthesia.
This chapter reviews a management strategy for transforming an outpatient surgery centre from that which exclusively uses general anaesthesia to one using regional anaesthesia with peripheral nerve blocks. Barriers presented by patients, nursing staff, surgeons and administrators can be notable; these might undermine the well-intended efforts of highly-skilled regionalists. ⋯ The centerpiece of the anaesthesia care process remains pre-emptive multimodal analgesia, routine multimodal antiemetic prophylaxis and avoidance of general anaesthesia (GA) with volatile agents. The remainder of the care process relies on teamwork among all healthcare providers and meaningful administrative support.