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Regional anesthesia can enhance postoperative pain control and perioperative outcomes in an ambulatory surgical setting.
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Many surgeries commonly performed in ambulatory surgical centers are amenable to nerve blocks.
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Proper needling technique, discussed in this article, helps minimize risk of adverse events.
Regional Anesthesia for Ambulatory Anesthesiologists
Section snippets
Key points
Interscalene Brachial Plexus Block
The interscalene block (ISB), which is performed at the level of the roots, encompasses mainly C5 to C7 blockade and can involve C3 to C4. Benefits of ISB include potential avoidance of volatile anesthetics, reduced opioid consumption and opioid-related side effects, fewer awakenings from pain, and improved postoperative analgesia and rehabilitation.2, 4 In patients undergoing rotator cuff repair, continuous interscalene block has shown improved analgesia and reduced opioid requirements
Paravertebral Block
Paravertebral nerve blocks (PVBs) present an opportunity to block multiple mixed nerve roots soon after they emerge from the intervertebral foramina, thus delivering analgesia that follows a dermatomal distribution. The paravertebral space is a wedge-shaped anatomic compartment adjacent to the vertebral bodies. The space is defined anterolaterally by the parietal pleura; posteriorly by the superior costotransverse ligament (thoracic levels); medially by the vertebra, vertebral disk, and
Femoral Block
Blockade of the femoral nerve results in sensory deficit to the anterior medial thigh and medial leg to the foot. Motor blockade involves the muscles of the anterior thigh, including the vastus medialis, vastus lateralis, and vastus intermedius, along with the sartorius muscle and rectus femoris. A femoral nerve block can result in significant weakness of the quadriceps.
Summary
Regional anesthesia can provide extensive benefits for ambulatory surgical patients. Proper regional anesthetic techniques can maximize patient comfort, promote postoperative discharge, and form an integral part of an effective and efficient perioperative practice. Knowledgeable and skilled anesthesiologists performing regional anesthesia can be the driving force behind excellence in patient satisfaction at ambulatory surgical centers.
Acknowledgments
The authors would like to thank Barys Ihnatsenka MD (Associate Professor of Anesthesiology, University of Florida) for his help in obtaining paravertebral images, and Shikha Bansal MBBS, MD (Fellow, Department of Anesthesiology, University of Toronto) for her contribution to the article.
References (30)
- et al.
Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council
J Pain
(2016) - et al.
Incidence of failure of continuous peripheral nerve catheters for postoperative analgesia in upper extremity surgery
J Hand Surg
(2014) - et al.
Ultrasound description of Pecs II (modified Pecs I): a novel approach to breast surgery
Rev Esp Anestesiol Reanim
(2012) - et al.
Analgesic efficacy of bilateral continuous transversus abdominis plane blocks using an oblique subcostal approach in patients undergoing laparotomy for gynaecological cancer: a prospective, randomized, triple-blind, placebo-controlled study
Br J Anaesth
(2016) - et al.
For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia
Anesthesiology
(2005) - et al.
Additives to local anesthetics for peripheral nerve blockade
Int Anesthesiol Clin
(2011) - et al.
Continuous interscalene nerve block following adhesive capsulitis manipulation
Reg Anesth Pain Med
(2013) - et al.
Continuous interscalene brachial plexus block for postoperative pain control at home: a randomized, double-blinded, placebo-controlled study
Anesth Analg
(2003) - et al.
Continuous interscalene block in patients having outpatient rotator cuff repair surgery: a prospective randomized trial
Anesth Analg
(2013) - et al.
Ambulatory continuous interscalene nerve blocks decrease the time to discharge readiness after total shoulder arthroplasty: a randomized, triple-masked, placebo-controlled study
Anesthesiology
(2006)
Ultrasound-guided interscalene block: reevaluation of the “stoplight” sign and clinical implications
Reg Anesth Pain Med
(2016)
One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography
Anesth Analg
(1991)
Hemidiaphragmatic paresis during interscalene brachial plexus block: effects on pulmonary function and chest wall mechanics
Anesth Analg
(1992)
The corner pocket revisited
Reg Anesth Pain Med
(2011)
Randomized comparison of extrafascial versus subfascial injection of local anesthetic during ultrasound-guided supraclavicular brachial plexus block
Reg Anesth Pain Med
(2015)
Cited by (24)
Postoperative pain and opioid use after breast reduction with or without preoperative nerve block
2022, Journal of Plastic, Reconstructive and Aesthetic SurgeryCitation Excerpt :In BRM, preoperative nerve blocks have been found to significantly decrease intraoperative opioid administration, postoperative nausea, and vomiting, and patient-reported pain when first awakening from anesthesia.12 Furthermore, erector spinae nerve blocks are easy to administer using ultrasound guidance and are considered very safe, with no major reported complications apart from a single reported case of pneumothorax.11,13–15 However, no studies have evaluated yet the role of peripheral nerve blocks in reducing postoperative opioid consumption in BRM.
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Disclosure: The authors have nothing to disclose.
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