Spinal anesthesia improves the early recovery profile of patients undergoing ambulatory knee arthroscopy

Short Communication: Lumbar Plexus Block versus Suprainguinal Fascia Iliaca Block to Provide Analgesia Following Hip and Femur Surgery in Pediatric-Aged Patients - An Analysis of a Case Series

Introduction

For surgical procedures involving the hip and femur, various regional anesthetic techniques may be used to provide analgesia. Although there has been an increase in the use of lumbar plexus block (LPB), the technique may be time consuming and associated with complications. Suprainguinal fascia iliaca compartment block (FICB) is a potentially easier and safer alternative. The current study prospectively compares LPB with suprainguinal FICB.

Methods

This prospective, double-blinded, randomized, study included patients undergoing elective orthopedic procedures of the hip and/or femur. All study patients received general anesthesia with randomization to either an LPB or suprainguinal FICB using 0.5% ropivacaine with epinephrine and dexamethasone. Postoperative pain control was achieved with intravenous hydromorphone delivered by patient-controlled analgesia with scheduled acetaminophen and ketorolac. Outcome data included time to perform the block, perioperative opioid consumption, postoperative pain scores (VAS) and hospital length of stay.

Results

The study cohort included 15 patients between the ages of 7 and 16 years (LPB N = 7, FICB N = 8). The median block time was 6 minutes (IQR: 4.11) for the LPB group and 3 minutes (IQR: 3.6) for the FICB group (p = 0.107). Median postoperative pain scores were 4 (IQR: 0.6) for the LPB group and 2 (IQR: 0.5) for the FICB group (p = 0.032). There were no differences in the intraoperative or postoperative opioid and NSAID use between the two groups.

Discussion

The suprainguinal FICB provides analgesia that is at least as effective as a LPB following hip and femur surgery. Time to perform the block was shorter with the FICB due to the supine patient position and limited needle trajectory. Although we noted no adverse effects, the superficial needle trajectory of the FICB offers a less invasive approach and the potential for decreased risks of adverse effects.

Knee surgery recovery: Post-operative Quality of Recovery Scale comparison of age and complexity of surgery

BACKGROUND

Initial validation and feasibility for the Post-operative Quality of Recovery Scale (PQRS) was published in 2010. Ongoing validation includes studies to determine whether this scale can discriminate differences in recovery between cohorts.

METHODS

A prospective cohort study included 61 patients, 18-40 years, and 61 patients, aged ≥ 65 years, undergoing knee arthroscopy under general anaesthesia; and 13 patients, aged ≥ 65 years, undergoing total knee replacement under general anaesthesia. Patients were assessed using the PQRS. Assessments were performed pre-surgery, at 15 and 40 min, 1 and 3 days, and 3 months after surgery.

RESULTS

The effect of age was assessed by comparing young versus older arthroscopy patients. There were minimal differences in recovery profiles, other than for the nociceptive domain, where pain recovery was significantly better in the older arthroscopy patients (P < 0.001). The effect of surgery was assessed by comparing older patients undergoing knee arthroscopy with knee replacement patients. Recovery was significantly worse for the knee replacement group for cognition (P = 0.015), nociception (pain and nausea, P < 0.001), activities of daily living (P < 0.001), emotive recovery (P = 0.029), and all-domains recovery (P < 0.001). Despite differences in quality of recovery, satisfaction was high in all cohorts.

CONCLUSIONS

Knee replacement had a large effect on recovery compared with knee arthroscopy. Age had minimal effect on recovery after knee arthroscopy. The study showed the ability of the PQRS to discriminate recovery in different domains.

Regional anesthesia for children undergoing orthopedic ambulatory surgeries in the United States, 1996-2006

BACKGROUND

Our objective was to evaluate national trends in regional anesthetic techniques among children undergoing ambulatory orthopedic procedures.

PURPOSE AND QUESTIONS

We aimed to determine whether an increase in regional anesthetics was primarily driven by an increase in the number of peripheral nerve blocks performed rather than an increase in neuraxial techniques. We further aimed to determine whether the proportion of peripheral nerve blocks performed in conjunction with general anesthesia has increased over time.

PATIENTS AND METHODS

Our study sample included any pediatric patient (i.e., <18 years old) who underwent an orthopedic ambulatory procedure in 1996 and 2006. We obtained data on ambulatory surgical procedures by accessing the Centers for Disease Control and Prevention's National Survey of Ambulatory Surgery. Patient demographics (age, gender), procedure information, and anesthesia-related variables were analyzed for each year.

RESULTS

The proportion of peripheral nerve blocks performed for ambulatory surgery more than doubled from 1996 (4.4 %) to 2006 (8.1 %). A significantly larger proportion of orthopedic procedures were being performed with a combination of peripheral nerve blocks and general anesthesia (1.2 % in 1996 and 43 % 2006). The use of neuraxial anesthesia for lower extremity surgeries decreased over the 10-year period (1.1 and 0.4 % in 1996 and 2006, respectively).

CONCLUSIONS

There was a significant increase in the use of peripheral nerve blocks for children undergoing ambulatory orthopedic procedures in the USA, while neuraxial techniques became less common over the 10-year period. The peripheral nerve blocks were frequently performed in conjunction with general anesthesia.

Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance

Obesity is associated with a number of anaesthetic-related risks. Regional anaesthesia offers many potential advantages for the obese surgical patient. Advantages include a reduction in systemic opioid requirements and their associated side effects, and possible avoidance of general anaesthesia in select circumstances, with a lower rate of complications. Historically, performing regional anaesthesia procedures in the obese has presented challenges due to difficulty in identifying surface landmarks and availability of appropriate equipment. Ultrasound guidance may aid the regional anaesthesia practitioner with direct visualisation of underlying anatomic structures and real-time needle direction. Further research is needed to determine optimal regional anaesthesia techniques, local anaesthetic dosage and perioperative outcomes in obese patients.

A comparison of intraarticular morphine and bupivacaine for pain control and outpatient status after an arthroscopic knee surgery under a low dose of spinal anaesthesia

Effective pain control is important after an outpatient arthroscopic knee surgery to permit early discharge and improve outcome. The aim of this study was to compare intraarticular morphine and bupivacaine with placebo for postoperative pain control and outpatient status after a knee arthroscopic surgery under a low dose of spinal anaesthesia. After obtaining the ethic committee's approval and written informed consents from 60 adult outpatients undergoing knee arthroscopy, patients were enrolled in this prospective, randomized, double-blinded, placebo-controlled clinical study. All patients received spinal anaesthesia with 1.4 ml of hyperbaric bupivacaine 0.5%. Patients were randomly divided into three groups as morphine (group M, n =20), bupivacaine (group B, n = 20), and placebo (group C, n = 20). After the surgical procedure, patients received one of the following solutions intraarticularly in a double-blinded randomized manner: 5 mg morphine in 20 ml saline, 20 ml 0.25% bupivacaine, or 20 ml saline. Postoperative pain was assessed using a 10-cm visual analogue scale (VAS). Patient characteristics, hemodynamic values, sensory and motor blocks, VAS values, rescue analgesics, discharge time, and patient satisfaction were recorded. There were no significant differences in patient characteristics, surgery and tourniquet time, hemodynamic values, and sensory and motor blocks. The VAS values at 30, 60, and 90 min were similar among the three groups. The VAS values at rest and during move were higher in group C than in groups M and B at 120, 150, 180 min, and 24 h (P < 0.001). There was no difference in VAS values between the groups M and B. Rescue analgesics used and discharge time were significantly different in the placebo group when compared to groups M and B (P < 0.001). Side effects were similar among the groups. Patient satisfaction scores were high in the groups M and B. Administration of 5 mg morphine and 20 ml of 0.25% bupivacaine intraarticularly provides better pain relief and shorter discharge time without increasing the side effects than placebo for an outpatient arthroscopic knee surgery performed under a low dose of spinal anaesthesia.

Time duration to safety sitting in parturient receiving spinal anesthesia for cesarean section with 0.5% Bupivacaine and morphine

Background: Spinal anesthesia has been used for cesarean section for a long time. However, the proportion of post-cesarean paturients who were able to sit at the fourth hour still remains unclear. Objective: Investigate the proportion of post-cesarean paturients that were able to sit at the fourth hour following spinal anesthesia with 0.5% hyperbaric bupivacaine and morphine. Furthermore, investigate the optimum time to encourage ambulation, and the risk factors delaying time duration to sit. Methods: A prospective observational study was conducted in 240 patients with American Society of Anesthesiologists physical status classification I and II, and single pregnancy parturients undergoing cesarean section. The patients who had body mass index (BMI) >35, estimated blood loss >1000 mL, needed postoperative bed rest, or received postoperative sedation were excluded. Hyperbaric bupivacaine 8-11 mg and morphine 0.2-0.3 mg were used. The patients were evaluated at the fourth hour until they could sit without adverse events or complete the sixth hour. All patients were evaluated for risk factors delaying the time duration to sit. Results: Out of 240 patients, 77.0%, 90.9%, and 98.4% were able to sit at the fourth, fifth, and sixth hour, respectively. The risk factors that delayed time to sit were Bromage scale >1 and pain score >3 by the univariate analysis, and were Bromage scale >1 and pain score >3 by the multivariate analysis. Conclusion: Seventy-seven percent of the patients could sit at the fourth hour, and most patients (98%) could sit at the sixth hour. The risk factors that delayed the time duration to sit were Bromage score >1 and pain score >3.

The influence of various anesthesia techniques on postoperative recovery and discharge criteria among geriatric patients

OBJECTIVE

We aim to compare selective spinal anesthesia and general anesthesia with regard to postoperative recovery and fast-track eligibility in day surgeries.

MATERIALS AND METHOD

Sixty geriatric outpatient cases, with ASA II-III physical status and requiring short-duration transurethral intervention, were enrolled in the study. The cases were split into 2 groups: as general anesthesia (Group GA) and selective spinal anesthesia (Group SSA). Group GA (n = 30) received propofol 2 mg kg⁻¹ (until loss of eyelash reflex), remifentanil induction 0.5-1 µg kg⁻¹, and laryngeal mask. Maintenance was achieved by 4-6% desflurane in 60% N₂O and 40% O₂ along with remifentanil infusion at 0.05 µg /kg⁻¹ /min⁻¹. Drugs were discontinued after the withdrawal of the ureteroscope, and extubation was carried out with 100% O₂. Group SSA (n = 30) received 0.5% spinal anesthesia via L4-5 space by 0.5% hyperbaric bupivacaine 5 mg. Anesthesia preparation time, time to surgical anesthesia level, postoperative fast-tracking, and time to White-Song recovery score of 12, were noted. In the operating room, we evaluated hemodynamics, nausea/vomiting, surgeon and patient satisfaction with anesthesia, perioperative midazolam-fentanyl administration, postoperative pain, and discharge time.

RESULTS

Anesthesia preparation time, length of surgery, anesthesia-related time in the operating room, time to sit, and time to walk were significantly low in Group GA (p < 0.05), whereas time to fast-track eligibility, length of stay in the PACU, discharge time, and other parameters were similar in both of the groups.

CONCLUSION

While anesthesia preparation time, length of surgery, start time of surgery, time to sit, and time to walk were shorter in the General Anesthesia group, time to fast-track eligibility, phase 1 recovery time, and discharge time were similar among patients subjected to selective spinal anesthesia.

Spinal mepivacaine with fentanyl for outpatient knee arthroscopy surgery: a randomized controlled trial

BACKGROUND

The foremost limitation of local anesthetic solutions for spinal anesthesia in the outpatient setting is prolonged motor blockade and delayed ambulation. The purpose of this study was to determine if the addition of intrathecal fentanyl to low-dose spinal mepivacaine provides adequate anesthesia with shorter duration of functional motor blockade for ambulatory knee surgery compared with spinal mepivacaine alone.

METHODS

Following institutional review board approval and informed consent, 34 patients undergoing unilateral knee arthroscopy were enrolled in this study. The patients were randomly assigned to receive either 30 mg of isobaric mepivacaine 1.5% plus fentanyl 10 microg (M + F group) or 45 mg of isobaric mepivacaine 1.5% alone (M group) intrathecally. Postoperatively, the times to achieve sensory block regression to the S1 dermatome and to attain functional motor block recovery enabling ambulation were recorded. All assessments were blinded.

RESULTS

The time to completion of Phase I recovery was shorter in the M + F group (104.6 +/- 28.4 min) than in the M group (129.1 +/- 30.4 min; P = 0.023). Regression of sensory blockade to S1 was earlier in the M + F group (118.4 +/- 53.5 min) than in the M group (169.7 +/- 38.9 min; P = 0.003). Patients in the M + F group (176.4 +/- 40.3 min) were able to ambulate significantly earlier than those in the M group (205.6 +/- 31.4 min; P = 0.025). No cases of transient or persistent neurological dysfunction were noted.

CONCLUSIONS

When compared with 45 mg isobaric mepivacaine 1.5%, an intrathecal dose of 30 mg isobaric mepivacaine 1.5% plus 10 microg fentanyl produces reliable anesthesia, hastens block regression, shortens stay in Phase I recovery, and enables earlier ambulation for patients undergoing unilateral knee arthroscopy (Registration no. NCT00803725).

[Pain therapy for the lower extremities]

Pain therapy after surgical procedures of the lower extremity is an important goal, whereas insufficient analgesia leads to an essential reduction of the patient's mobility and convalescence. If possible, regional anaesthetic and intrathecal procedures for pre-, intra- and postoperative analgesia should be used. Systemic analgesics should not be used preoperatively, whereas non-opioids and opioids are recommended postoperatively. Surgical options that adequately reduce pain are intra-articular injection of local anaesthetics alone or in combination with opioids and cooling and physiotherapeutic treatment regimens after joint procedures. There is no scientific rationale as an argument for inserting drains. The surgical approach depends more on the individual patient's anatomical characteristics. Whereas the regional analgesic regimen is more effective than systemic therapy, sufficient tools for pain reduction during surgical procedures of the lower extremity are at the orthopaedic surgeon's disposal, too.

Advances in regional anesthesia for outpatients

PURPOSE OF REVIEW

This review will bring to the reader's attention recent developments in the literature regarding regional anesthesia in the outpatient setting, and allow the reader to evaluate whether these developments are appropriate for inclusion in clinical practice.

RECENT FINDINGS

The most stimulating developments in the area of regional anesthesia for outpatients revolve around the use of continuous analgesic therapy for outpatients after discharge. This is reflected in recent publications describing the use of continuous catheters for peripheral nerve blockade using portable pumps to provide 48-72 h of postoperative analgesia. These devices have raised the hope of opioid-free pain relief for virtually the entire duration of postsurgical pain in the outpatient setting. There are also increasing numbers of suggestions on ways to improve the quality of spinal anesthesia in the outpatient setting, particularly by using lower doses of lidocaine to reduce the problem of transient neurologic symptoms after spinal blockade. Several authors have investigated the cost implications of regional techniques in the outpatient setting, and have concluded that they are very competitive with the general anesthetic techniques that are frequently employed.

SUMMARY

Recent publications suggest additional ways to add regional anesthesia techniques to outpatient surgical practice, particularly with the promise of extensive postoperative pain relief for the ambulatory surgery patient.

A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials

Both regional anesthesia and general anesthesia have been proposed to provide optimal ambulatory anesthesia. We searched MEDLINE and other databases for randomized controlled trials comparing regional anesthesia and general anesthesia in ambulatory surgery patients for meta-analysis. Only major conduction blocks were considered to be regional anesthesia. Regional anesthesia was further separated into central neuraxial block and peripheral nerve block. Fifteen (1003 patients) and 7 (359 patients) trials for central neuraxial block and peripheral nerve block were included in the meta-analysis. Both central neuraxial block and peripheral nerve block were associated with increased induction time, reduced pain scores, and decreased need for postanesthesia care unit analgesics. However, central neuraxial block was not associated with decreased postanesthesia care unit bypass or time or reduced nausea despite reduced analgesics, and it was associated with a 35-min increase in total ambulatory surgery unit time. In contrast, peripheral nerve block was associated with decreased postanesthesia care unit need and decreased nausea but, again, not with decreased ambulatory surgery unit time. This meta-analysis indicates potential advantages for regional anesthesia, such as decreased postanesthesia care unit use, nausea, and postoperative pain. Although these factors have been proposed to reduce ambulatory surgery unit stay, neither central neuraxial block nor peripheral nerve block were associated with reduced ambulatory surgery unit time. Other factors, such as unsuitable discharge criteria and limitations of meta-analysis, may explain this discrepancy.

Transient Neurologic Symptoms After Spinal Anesthesia with Lidocaine Versus Other Local Anesthetics: A Systematic Review of Randomized, Controlled Trials

Lidocaine has been used for spinal anesthesia since 1948, seemingly without causing concern. However, during the last 10 years, a number of reports have appeared implicating lidocaine as a possible cause of neurologic complications after spinal anesthesia. Follow-up of patients who received uncomplicated spinal anesthesia revealed that some of them developed pain in the lower extremities--transient neurologic symptoms (TNS). In this study, we sought to compare the frequency of 1) TNS and 2) neurologic complications after spinal anesthesia with lidocaine with that after other local anesthetics. Published trials were identified by computerized searches of The Cochrane Library, MEDLINE, LILAC, and EMBASE and by checking the reference lists of trials and review articles. The search identified 14 trials reporting 1347 patients, 117 of whom developed TNS. None of these patients showed signs of neurologic complications. The relative risk for developing TNS after spinal anesthesia with lidocaine was higher than with other local anesthetics (bupivacaine, prilocaine, procaine, and mepivacaine), i.e., 4.35 (95% confidence interval, 1.98-9.54). There was no evidence that this painful condition was associated with any neurologic pathology; in all patients, the symptoms disappeared spontaneously by the 10th postoperative day.

Peripheral Nerve Blocks Result in Superior Recovery Profile Compared with General Anesthesia in Outpatient Knee Arthroscopy

It has been suggested that use of peripheral nerve blocks (PNBs) may have some potential benefits in the outpatient setting. There have been no studies specifically comparing PNBs performed with short-acting local anesthetics with general anesthesia (GA) in patients undergoing outpatient knee surgery. We hypothesized that a combination of lumbar plexus and sciatic blocks using a short-acting local anesthetic will result in shorter time-to-discharge-home as compared with GA. Patients scheduled to undergo knee arthroscopy were randomized to receive a GA (midazolam, fentanyl, propofol, N(2)O/O(2)/desflurane via laryngeal mask airway) or lumbar plexus/sciatic block (PNBs; 2-chloroprocaine). Patients given GA also received an intraarticular injection of 20 mL 0.25% bupivacaine for postoperative pain control. Patients in the PNB group were given midazolam (up to 4 mg) and alfentanil (500-750 microg) before block placement and propofol 30-50 microg . kg(-1) . min(-1) for intraoperative sedation. Relevant perioperative times, postanesthesia care unit bypass rate, severity of pain, and incidence of complications were compared between the two groups. Fifty patients were enrolled in the study; 25 patients each received GA or PNBs. Total operating room time did not differ significantly between the 2 groups (97 +/- 37 versus 91 +/- 42 min). Seventy-two percent of patients receiving PNB met criteria enabling them to bypass Phase I postanesthesia care unit compared with only 24% of those receiving GA (P < 0.002). Time to meet criteria for discharge home (home readiness) and time to actual discharge were significantly shorter for patients given PNBs than for patients given GA (131 +/- 62 versus 205 +/- 94 and 162 +/- 71 versus 226 +/- 96, respectively). Under the conditions of our study, the combination of lumbar plexus and sciatic blocks with 2-chloroprocaine 3% was associated with a superior recovery profile compared with GA in patients having outpatient knee arthroscopy.

A Comparison of Psoas Compartment Block and Spinal and General Anesthesia for Outpatient Knee Arthroscopy

The optimal anesthetic technique for outpatient knee arthroscopy remains controversial. In this study, we evaluated surgical operating conditions, patient satisfaction, recovery times, and postoperative analgesic requirements associated with psoas compartment block, general anesthetic, or spinal anesthetic techniques. Sixty patients were randomized to receive a propofol/nitrous oxide/fentanyl general anesthetic, spinal anesthesia with 6 mg of bupivacaine and 15 micro g of fentanyl, or psoas compartment block with 40 mL of 1.5% mepivacaine. All patients received IV ketorolac and intraarticular bupivacaine. The frequency of postanesthesia recovery room admission was 13 (65%) of 20 for patients receiving general anesthesia, compared with 0 of 21 for patients receiving spinal anesthesia and 1 (5%) of 19 for patients receiving psoas block (P < 0.001). The median time from the end of surgery to meeting hospital discharge criteria did not differ across groups (131, 129, and 110 min for general, spinal, and psoas groups, respectively). In the hospital, 45% of general anesthesia patients received opioid analgesics, compared with 14% of spinal anesthesia and 21% of psoas block patients (P = 0.087). There was no difference among groups with respect to the time of first analgesic use or the number of patients requiring opioid analgesia. Pain scores were highest in patients receiving general anesthesia at 30 min (P = 0.032) and at 60, 90, and 120 min (P < 0.001). Patient satisfaction with anesthetic technique (P = 0.025) and pain management (P = 0.009) differed significantly across groups; patients receiving general anesthesia reported lower satisfaction ratings. We conclude that spinal anesthesia or psoas block is superior to general anesthesia for knee arthroscopy when considering resource utilization, patient satisfaction, and postoperative analgesic management.

IMPLICATIONS

Outpatient knee arthroscopy may be performed using a variety of anesthetic techniques. We report that spinal anesthesia and psoas compartment block are superior to general anesthesia when considering resource utilization, patient satisfaction, and postoperative analgesic management.

General anaesthesia or spinal anaesthesia for outpatient urological surgery

BACKGROUND AND OBJECTIVE

A variety of drugs and techniques have been introduced into ambulatory anaesthesia. The technique as well as the drugs used may hasten or delay home discharge. We compared recovery profiles and side-effects of spinal anaesthesia and total intravenous anaesthesia.

METHODS

Forty unpremedicated ASA I-II patients (18-65 yr) undergoing varicocele repair were randomly divided into two groups. Spinal anaesthesia (26-G atraumatic needle) with hyperbaric bupivacaine 0.5% 5 mg and fentanyl 25 microg were given to patients in Group Spinal (n = 20). Patients in Group TIVA (n = 20) received total intravenous anaesthesia with propofol and remifentanil given by continuous infusion; a laryngeal mask was used to secure the airway. The duration of surgery, time to home readiness and side-effects were recorded.

RESULTS

The two groups were comparable with respect to patients' characteristics and duration of surgery. The times to achieve ambulation were similar between groups (Spinal = 78.4 +/- 40.9 min, TIVA = 75.9 +/- 13.8 min). Urinary voiding was a requirement for discharge after spinal anaesthesia and the time for home readiness was longer in Group Spinal (158.0 +/- 40.2 versus 94.9 +/- 18.8 min) (P < 0.05). Two patients reported pruritus and one reported postdural puncture headache in Group Spinal, whereas two patients reported nausea in Group TIVA. Patients in Group TIVA had a greater need for analgesia postoperation (P < 0.05).

CONCLUSIONS

In healthy unpremedicated men undergoing minor urological operations, total intravenous anaesthesia with remifentanil and propofol provided as safe and effective anaesthesia as spinal block with the advantage of earlier home readiness.

A comparison of two regional anesthetic techniques for outpatient knee arthroscopy

IMPLICATIONS

Small dose lidocaine spinal anesthesia and 3% 2-chloroprocaine epidural anesthesia provided comparable discharge times for outpatient knee arthroscopy. The incidence of transient neurologic symptoms with small-dose lidocaine spinal anesthesia was 12%.

Postoperative recovery and discharge

Ambulatory surgery provides quality care that is cost-effective. The use of innovative surgical and anesthetic techniques will allow larger numbers of patients to take advantage of the benefits of undergoing an elective operation on an ambulatory basis. Anesthesiologists will be faced with more complex surgery, which will require careful selection and assessment of patients to ensure continuity of the excellent safety record of ambulatory anesthesia. Minor adverse events, such as pain and PONV, are still common. The occurrence of these minor adverse advents is now the major area of quality assessment and an area where improvement could be targeted. Fast tracking facilitates earlier discharge, but we must ensure this has benefit to the patient as speedy discharge may mask the true incidence of adverse minor symptoms. This can lead to patient dissatisfaction and a poor impression of ambulatory surgery.

Regional anesthesia for outpatient surgery

In summary, regional techniques offer significant advantages in the outpatient setting. They can avoid the side effects of nausea, vomiting, and pain that frequently delay discharge or cause admission. They can also provide prolonged analgesia as well as offer, with the use of continuous catheters, the promise of a pain-free perioperative period. The choice of drugs must be carefully adjusted, especially with neuraxial techniques. Despite frequently requiring some additional time at the outset, regional techniques have consistently been shown to provide competitive discharge times and costs when compared with general anesthesia. They deserve a prominent place in outpatient surgery.

Selective spinal anesthesia versus desflurane anesthesia in short duration outpatient gynecological laparoscopy: a pharmacoeconomic comparison

We compared the cost and effectiveness of selective spinal anesthesia (SSA) with a desflurane-based general anesthetic (DES) for outpatient gynecological laparoscopy. A prospective analysis was undertaken of 10 patients randomized to receive SSA and compared with 10 patients randomized to receive DES. The groups were well matched in their demographic characteristics. The mean cost (in 2000 Canadian dollar values) of anesthesia supplies, drugs, and nursing for the SSA group of $62.31 was less than that for the DES group of $92.31 (P < 0.01). Recovery costs of both groups were similar. Time to administer anesthesia and time spent in the postanesthetic care unit were also similar. Postoperative analgesia was required by 50% of the DES group but in no patient receiving SSA (P < 0.01). SSA is a cost-effective alternative to DES in these patients.

IMPLICATIONS

Small-dose spinal anesthesia is an effective alternative to a desflurane general anesthetic in terms of cost and recovery profiles in ambulatory gynecological laparoscopy.