Reduction of operating and recovery room times and overnight hospital stays with interscalene blocks as sole anesthetic technique for rotator cuff surgery.

BACKGROUND: The effort to decrease hospital stays and to increase operating room efficacy has become an important consideration in the practice of anesthesia. METHODS: Fifty-three patients who underwent shoulder rotator cuff repair in the sitting position were divided into four groups according to the anesthesia technique used: Group 1 (general anesthesia), Group 2 (interscalene block), Group 3 (interscalene combined with general anesthesia) and Group 4 (general anesthesia combined with local injection of local anesthetics). Interscalene blocks were performed preoperatively, using a nerve stimulator. After appropriately locating the brachial plexus, a mixture of 40 ml of 2% lidocaine and 0.5% bupivacaine (v/v) was injected. RESULTS: As compared to general anesthesia, the use of an interscalene block alone reduced the following operating room times: 1) from the patient's arrival in the operating room to the beginning of surgery and 2) from the end of surgery to the patient's departure from the operating room. Use of the interscalene block also resulted in a reduction of recovery time when compared to Groups 1, 3 and 4 by 40, 56 and 66%, respectively. Compared to Group 1, this anesthesia technique was furthermore associated with a 64% decrease in the number of patients hospitalized overnight. CONCLUSIONS: This study confirms that the interscalene block as sole anesthesia technique is safe and effective and can contribute to shorten the hospital length of stay of patients undergoing shoulder rotator cuff surgery.

Regional anesthesia for outpatient orthopedic surgery.

The constant search for increased efficiency and reduction of hospital length of stay has led to an increase number of major orthopedic procedures performed as outpatients and the increase in the associated intensity and duration of acute postoperative pain. Although, it is well established that single peripheral blocks provide adequate anesthesia and excellent immediate postoperative analgesia in patients undergoing minor ambulatory orthopedic surgery, the postoperative acute pain benefit is limited to less than 24 hours. However, many patients required over 24 hours of intensive postoperative analgesia. Furthermore the need for immediate postoperative physical therapy in orthopedics dictates that local anesthetics be chosen on the basis of their safety and ability to produce preferential sensory blocks. As early as 1946, Ansbro proposed the use of continuous nerve blocks to prolong the duration of analgesia of nerve block technique during anesthesia. Continuous nerve blocks have also been used for the acute postoperative pain control of patients undergoing major orthopedic surgery as in-patients. This technique has been proven to be safe and effective in controlling acute postoperative pain and improve functional outcome. The recent introduction of safer local anesthetics producing preferential sensory blocks along with the development of ambulatory pumps has allow to extend the use of these continuous block techniques to ambulatory patients. Recent development also included the use of cox2 inhibitors along with cold maximize postoperative analgesia. This multimodal approach has been proven to be safe and efficacious as much for resting pain than pain associated with exercise.