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Impact of parallel processing of regional anesthesia with block rooms on resource utilization and clinical outcomes: a systematic review and meta-analysis
  1. Kariem El-Boghdadly1,2,
  2. Ganeshkrishna Nair1,
  3. Amit Pawa1 and
  4. Desire N. Onwochei1
  1. 1 Deparment of Anaesthesia and Perioperative Medicine, Guy’s and Saint Thomas’ NHS Foundation Trust, London, UK
  2. 2 King’s College London, London, UK
  1. Correspondence to Dr Kariem El-Boghdadly, Anaesthesia, Guy's and Saint Thomas' NHS Foundation Trust, London SE1 7EH, UK; elboghdadly{at}


Block rooms allow parallel processing of surgical patients with the purported benefits of improving resource utilization and patient outcomes. There is disparity in the literature supporting these suppositions. We aimed to synthesize the evidence base for parallel processing by conducting a systematic review and meta-analysis. A systematic search was undertaken of Medline, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the National Health Service (NHS) National Institute for Health Research Centre for Reviews and Dissemination database, and Google Scholar for terms relating to regional anesthesia and block rooms. The primary outcome was anesthesia-controlled time (ACT; time from entry of the patient into the operating room (OR) until the start of surgical prep plus surgical closure to exit of patient from the OR). Secondary outcomes of interest included other resource-utilization parameters such as turnover time (TOT; time between the exit of one patient from the OR and the entry of another), time spent in the postanesthesia care unit (PACU), OR throughput, and clinical outcomes such as pain scores, nausea and vomiting, and patient satisfaction. Fifteen studies were included involving 8888 patients, of which 3364 received care using a parallel processing model. Parallel processing reduced ACT by a mean difference (95% CI) of 10.4 min (16.3 to 4.5; p<0.0001), TOT by 16.1 min (27.4 to 4.8; p<0.0001) and PACU stay by 26.6 min (47.1 to 6.1; p=0.01) when compared with serial processing. Moreover, parallel processing increased daily OR throughout by 1.7 cases per day (p<0.0001). Clinical outcomes all favored parallel processing models. All studies showed moderate-to-critical levels of bias. Parallel processing in regional anesthesia appears to reduce the ACT, TOT, PACU time and improved OR throughput when compared with serial processing. PROSPERO CRD42018085184.

  • regional anesthesia
  • economics
  • outcomes

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  • Twitter @elboghdadly, @drgnair, @DesireOnwochei

  • Presented at Interim data from this work was presented at the 2018 World Congress on Regional Anesthesia and Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine in New York, 19 to 21 April 2018.

  • Contributors Study conception and design; data analysis; manuscript preparation: KE. Study conduct: KE, GN and DO. Manuscript revision and manuscript approval: all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. KE has received educational and research funding from Fisher & Paykel Healthcare, GE Healthcare and Ambu. AP has received educational funding from GE Healthcare and consults for B Braun Medical. These have no influence on the submitted work.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analyzed for this study. Not applicable.