The type of anesthesia is only one of several determinants of length of stay (LOS) in hospitals. The role of anesthesia on LOS may be in its predisposition to or avoidance of postoperative complications such as pulmonary or cardiac dysfunction. If one presumes pulmonary complications are those most directly related to anesthetic techniques, then efforts to reduce these problems must be aimed at treatment of postoperative pain and avoidance of respiratory depression. These are the two major contributors to pulmonary dysfunction, along with failure to ambulate.
Three studies addressed the role of 1) general anesthetics, 2) general anesthetics vs. intercostal block, and 3) intercostal block vs. narcotics in altering arterial blood gases intra- and postoperatively. Blood gas measurements were used as a crude guide to altered pulmonary function. Although little difference was noted in the operative anesthetic studies, there were significant findings in the third study comparing intercostal block vs. narcotics for postoperative analgesia. Forty-two patients divided into four groups were followed to discharge. Those patients who received only intercostal blocks ambulated earlier and were discharged from the hospital earlier than those patients receiving only narcotics.
The future role of anesthesia personnel, techniques, and drugs in the control of postoperative pain and complications is a broad question. Clearly, anything which reduces postoperative complications and LOS has far-reaching economic and social implications.
- intercostal block
- length of stay
- Narcotic analgesia
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