Advances in regional anesthesia for outpatients

Current Opinion in Anaesthesiology

Volumn 15, Issue 6, 2002, Pages 641-645

  Mulroy, Michael F ^a  

^a VIRGINIA MASON MEDICAL CENTER   (United States)

Author keywords

Ambulatory anesthesia; Continuous catheters; Regional anesthesia; Spinal anesthesia

Indexed keywords

ANALGESIC AGENT; ANESTHETIC AGENT; BUPIVACAINE; BUPRENORPHINE; CLONIDINE; FENTANYL DERIVATIVE; LIDOCAINE; ROPIVACAINE;

AMBULATORY SURGERY; ANALGESIA; CATHETER; CLINICAL PRACTICE; COST; DEVICE; GENERAL ANESTHESIA; HOSPITAL DISCHARGE; HUMAN; HYPOTENSION; NERVE BLOCK; NEUROLOGICAL COMPLICATION; PERIPHERAL NERVE; POSTOPERATIVE ANALGESIA; POSTOPERATIVE PAIN; PRIORITY JOURNAL; PRURITUS; REGIONAL ANESTHESIA; RESPIRATION DEPRESSION; REVIEW; SEDATION; SIDE EFFECT; SPINAL ANESTHESIA; SYMPTOMATOLOGY;

EID: 0036923641     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001503-200212000-00007     Document Type: Review

References (28)

1. McGoldrick K. The role of spinal anesthesia in the ambulatory venue: Current issues and concerns: Editorial comment. Curr Opin Anaesthesiol 2001; 14;605-610.
2. Rawal N. Analgesia for day-case surgery. Br J Anaesth 2001; 87:73-87.
3. Rawal N, Alvin R, Axelsson K, et al. Patient-controlled regional analgesia (PCRA) at home. Anesthesiology 2002; 96:1290-1296. Patients were given infusions of ropivacaine or bupivacaine through continuous axillary catheters after hand surgery, and had excellent pain relief at home for 3 days. Patients controlled the infusions by releasing a clamp on an elastomeric bulb of local anesthetic.
4. Krone SC, Chan VW, Regan J, et al. Analgesic effects of low-dose ropivacaine for interscalene brachial plexus block for outpatient shoulder surgery: A dose-finding study. Reg Anesth Pain Med 2001; 26:439-443. The use of ropivacaine in any concentration can delay the onset of oral analgesia for 10 h following shoulder surgery, thus allowing the patients to be discharged pain free before taking oral analgesics at home.
5. Candido KD, Franco CD, Khan MA, et al. Buprenorphine added to the local anesthetic for brachial plexus block to provide postoperative analgesia in outpatients. Reg Anesth Pain Med 2001; 26:352-356. Buprenorphine prolonged the duration of analgesia in the brachial plexus for as long as 30 h. Other studies have not shown as dramatic an effect on addition of opioids to peripheral nerve block, and this may be an indication that further research is needed to confirm the advantages of postoperative pain relief with a single injection.
6. Mulroy MF, Larkin KL, Batra MS, et al. Femoral nerve block with 0.25 or 0.5% bupivacaine improves postoperative analgesia following outpatient arthroscopic anterior cruciate ligament repair. Reg Anesth Pain Med 2001; 26:24-29.
7. Grant SA, Nielsen KC, Greengrass RA, et al. Continuous peripheral nerve block for ambulatory surgery. Reg Anesth Pain Med 2001; 26:209-214.
8. Klein SM, Nielsen KC, Martin A, et al. Interscalene brachial plexus block with continuous intraarticular infusion of ropivacaine. Anesth Analg 2001; 93:601-605. The infusion of local anesthetic into the surgical site can provide prolonged analgesia comparable to the use of continuous peripheral nerve block.
9. Ilfeld BM, Enneking FK. A portable mechanical pump providing over four days of patient-controlled analgesia by perineural infusion at home. Reg Anesth Pain Med 2002; 27:100-104. A case report of an interscalene catheter providing 4 days of relief at home in a patient who had used only conventional analgesia on the opposite shoulder for a previous operation.
10. Ilfeld BM, Moery T, Enneking F. Continuous infraclavicular brachial plexus block for postoperative pain control at home. Anesthesiology 2002; 96:1297-1304. The authors compared 15 patients with infraclavicular infusion catheters with standard oral analgesia after arm surgery, and found better analgesia and sleep patterns with the catheters, with few technical problems.
11. Klein SM. Beyond the hospital: Continuous peripheral nerve blocks at home [editorial]. Anesthesiology 2002; 96:1283-1284. An editorial overview of the issues of continuous catheters at home.
12. Vaghadia H, Viskari D, Mitchell GW, Berrill A. Selective spinal anesthesia for outpatient laparoscopy. I: Characteristics of three hypobaric solutions. Can J Anaesth 2001; 48:256-260.
13. Lennox PH, Vaghadia H, Henderson C, et al. Small-dose selective spinal anesthesia for short-duration outpatient laparoscopy: Recovery characteristics compared with desflurane anesthesia. Anesth Analg 2002; 94:346-350.
14. Lennox PH, Chilvers C, Vaghadia H. Selective spinal anesthesia versus desflurane anesthesia in short duration outpatient gynecological laparoscopy: A pharmacoeconomic comparison. Anesth Analg 2002; 94:565-568. The small dose of lidocaine spinal anesthesia provided comparable discharge times to general anesthesia with desflurane, and at lower overall costs.
15. Ben-David B, Maryanovsky M, Gurevitch A, et al. A comparison of minidose lidocaine-fentanyl and conventional-dose lidocaine spinal anesthesia. Anesth Analg 2000; 91:865-870.
16. Mulroy MF, Larkin KL, Siddiqui A. Intrathecal fentanyl-induced pruritus is more severe in combination with procaine than with lidocaine or bupivacaine. Reg Anesth Pain Med 2001; 26:252-256.
17. De Kock M, Gautier P, Fanard L, et al. Intrathecal ropivacaine and clonidine for ambulatory knee arthroscopy: A dose-response study. Anesthesiology 2001; 94:574-578. While ropivacaine 8 mg alone did not produce satisfactory anesthesia for knee surgery, the addition of 15 mcg of donidine did produce better motor block without excessive prolongation of discharge, and without the systemic side effects seen with larger doses of clonidine supplementation.
18. Williams BA, Kentor ML, Williams JP, et al. Process analysis in outpatient knee surgery: Effects of regional and general anesthesia on anesthesia-controlled time. Anesthesiology 2000; 93:529-538.
19. Valanne JV, Korhonen AM, Jokela RM, et al. Selective spinal anesthesia: A comparison of hyperbaric bupivacaine 4 mg versus 6 mg for outpatient knee arthroscopy. Anesth Analg 2001; 93:1377-1379. Positioning and low dose can be combined to produce short-duration intense anesthesia for one leg.
20. Wong J, Marshall S, Chung F, et al. Spinal anesthesia improves the early recovery profile of patients undergoing ambulatory knee arthroscopy. Can J Anaesth 2001; 48:369-374.
21. Neal JM, Deck JJ, Kopacz DJ, Lewis MA. Hospital discharge after ambulatory knee arthroscopy: A comparison of epidural 2-chloroprocaine versus lidocaine. Reg Anesth Pain Med 2001; 26:35-40.
22. Mulroy MF, Larkin KL, Hodgson PS, et al. A comparison of spinal, epidural, and general anesthesia for outpatient knee arthroscopy. Anesth Analg 2000; 91:860-864.
23. Terheggen MA, Wille F, Borel Rinkes IH, et al. Paravertebral blockade for minor breast surgery. Anesth Analg 2002; 94:355-359.
24. Atanassoff PG, Ocampo CA, Bande MC, et al. Ropivacaine 0.2% and lidocaine 0.5% for intravenous regional anesthesia in outpatient surgery. Anesthesiology 2001; 95:627-631. Ropivacaine provides a slight prolongation of analgesia following the release of a tourniquet with intravenous regional anesthesia. Although this may provide comfort for 20 min, the clinical usefulness of this slight prolongation is questionable.
25. Chan VW, Peng PW, Kaszas Z, et al. A comparative study of general anesthesia, intravenous regional anesthesia, and axillary block for outpatient hand surgery: Clinical outcome and cost analysis. Anesth Analg 2001; 93:1181-1184. While brachial plexus block was comparable to general anesthesia in total time and cost for hand surgery, intravenous regional anesthesia provided significantly faster discharge and lower costs.
26. Kehlet H, White PF. Optimizing anesthesia for inguinal herniorrhaphy: General, regional, or local anesthesia? [editorial]. Anesth Analg 2001; 93:1367-1369.
27. Callesen T, Bech K, Kehlet H. One-thousand consecutive inguinal hernia repairs under unmonitored local anesthesia. Anesth Analg 2001; 93:1373-1376. These authors report a high degree of success and satisfaction in the use of local anesthesia for hernia repair. The patients also had significant postoperative analgesia.
28. Chilvers CR, Goodwin A, Vaghadia H, Mitchell GW. Selective spinal anesthesia for outpatient laparoscopy. V: Pharmacoeconomic comparison vs general anesthesia. Can J Anaesth 2001; 48:279-283. The selected spinal anesthesia with lidocaine was less expensive than the general anesthetic, based primarily on drug cost and recovery-room costs.