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Developing a business case for a regional anesthesia block room: up with efficiency, down with costs
  1. Yusuke Mazda1,
  2. Sharon Peacock2,
  3. Jesse Wolfstadt3,
  4. John Matelski4,
  5. Vincent Chan5 and
  6. Yehoshua (Josh) Gleicher2
  1. 1Division of Obstetric Anesthesia, Department of Anesthesiology, Saitama Medical Center, Kawagoe, Japan
  2. 2Anesthesiology and Pain Medicine, Sinai Health, Toronto, Ontario, Canada
  3. 3Surgery, Division of Orthopaedics, Sinai Health, Toronto, Ontario, Canada
  4. 4Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
  5. 5Department of Anesthsia, University Health Network-, Toronto, Ontario, Canada
  1. Correspondence to Dr Yehoshua (Josh) Gleicher, Anesthesia, University of Toronto, Toronto ON M5G 1X5, Canada; josh.gleicher{at}


Background Regional anesthesia techniques offer many benefits for total joint arthroplasty (TJA) patients. However, they require personnel and equipment resources, as well as valuable operating room (OR) time. A block room offers a dedicated environment to perform regional anesthesia procedures while potentially offsetting costs.

Methods The goal of this prospective quality improvement study was to develop a business case for implementation of a regional anesthesia block room and to demonstrate the cost-effectiveness of this program in decreasing OR time for TJA. All elective TJA patients presenting between January 2019 and March 2020 were included in our analysis.

Results Our detailed business plan was approved by the hospital leadership. 561 patients in the preintervention group and 432 in the postintervention group were included for data analysis. Mean total OR time per surgical case decreased from 166 to 143 min for a difference of 23 min (95% CI 17 to 29). Similarly, anesthesia controlled OR time decreased from 46 min to 26 min for a difference of 20 min (95% CI 17 to 22). The block room resulted in an additional primary TJA case per daily OR list. The percentage of TJA patients receiving a peripheral nerve block increased from 63.1% to 87.0% (p<0.001). No safety events or block room associated OR delays were observed.

Conclusion Implementing a regional anesthesia block room required a comprehensive business plan for securing the necessary resources to support the program. The regional anesthesia block room is a cost-effective method to improve patient care and OR efficiency.

  • analgesia
  • lower extremity
  • economics
  • nerve block
  • injections
  • spinal

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  • YM and SP are joint first authors.

  • Twitter @yusuke_mazda

  • Correction notice This article has been corrected since it published Online First. Dr Peacock's name has been corrected.

  • Contributors YM contributed to data collection. SP helped design and implement the study, and write the manuscript. JW helped design and implement the study, and critically reviewed manuscript. JM contributed to data and statistical analysis. VC critically reviewed manuscript. YG helped design and implement the study, analyze the data, and write the manuscript.

  • Funding Funding was provided by Sinai Health.

  • Competing interests None declared.

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