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Effect of peripheral nerve blocks on postanesthesia care unit length of stay in patients undergoing ambulatory surgery: a retrospective cohort study
  1. Victor Polshin1,
  2. Julie Petro2,
  3. Luca J Wachtendorf1,
  4. Maximilian Hammer1,
  5. Thomas Simopoulos1,
  6. Matthias Eikermann1,3 and
  7. Peter Santer1
  1. 1Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Department of Anesthesiology and Perioperative Medicine, Veterans Administration Hospital of Boston, West Roxbury, Massachusetts, USA
  3. 3Klinik für Anästhesiologie und Intensivmedizin, Universität Duisburg-Essen, Essen, Germany
  1. Correspondence to Dr Matthias Eikermann, Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; meikerma{at}bidmc.harvard.edu

Abstract

Background Peripheral regional anesthesia and analgesia may increase the efficiency of ambulatory surgical centers by reducing pain and preventing nausea and vomiting, which are important modifiable causes of prolonged postanesthesia care unit (PACU) length of stay. We hypothesized that the use of peripheral nerve blocks (PNB) was associated with shorter PACU length of stay in ambulatory surgery.

Methods In this retrospective cohort study, we analyzed data from adult ambulatory surgical cases, in which PNB was a viable anesthetic option (ie, was routinely performed for these procedures), at an academic medical center between 2008 and 2018. We assessed the association between the use of PNB and the primary endpoint of PACU length of stay. As key secondary endpoint, we compared intraoperative opioid doses. Analyses were adjusted for patient demographics, comorbidities and intraoperative factors.

Results A total of 57 040 cases were analyzed, of whom 13 648 (23.9%) received a PNB. The use of PNB was associated with shorter PACU length of stay (a decrease of 7.3 min, 95% CI 6.1 to 8.6, p<0.001). This association was most pronounced in surgeries of long duration (decrease of 11.2 min, 95% CI 9.0 to 13.4) and in patients undergoing leg and ankle procedures (decrease of 15.1 min, 95% CI 5.5 to 24.6). Intraoperative opioid doses were significantly lower in patients receiving a nerve block (decrease of 9.40 mg oral morphine equivalents, 95% CI 8.34 to 10.46, p<0.001).

Conclusion The use of PNB significantly reduced PACU length of stay in ambulatory surgical patients, which may in part be attributed to lower intraoperative opioid requirements.

  • ambulatory care
  • nerve block
  • outcome assessment
  • health care
  • analgesics
  • opioid

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Footnotes

  • Presented at Interim data from this work were presented at the ANESTHESIOLOGY 2019 Annual Meeting of the American Society of Anesthesiologists in Orlando, FL, October 19–23, 2019.

  • Contributors Study conception and design: VP, JP, TS, ME and PS. Data acquisition, data analysis: LJW, MH and PS. Supervision of data analysis: ME and PS. Interpretation of study results: all authors. Manuscript revision and approval: all authors.

  • Funding This work was supported by philanthropic donations from Jeffrey and Judy Buzen to ME.

  • Disclaimer The funders were not involved in the design of the study; in the collection, analysis, and interpretation of data; in the writing of the manuscript; or in the decision to submit the article for publication.

  • Competing interests ME has received unrestricted funds from philanthropic donors Jeffrey and Judy Buzen during the conduct of the study, has received grants for investigator-initiated trials not related to this manuscript from Merck & Co and serves as a consultant on the advisory board of Merck & Co.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request. Deidentified data will be made available upon reasonable written request submitted to the corresponding author.

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