Archive June 2014 XV, No. 6

Regional Anesthesia's Economic Advantages

Peripheral nerve blocks save dollars and make sense.

David Bernard, Senior Associate Editor

— A BETTER WAY Ultrasound isn't the only option for peripheral nerve block placement, "but once you start using it, you become hooked," says David Rosen, MD, president of Midwest Anesthesia Partners.

Ask any anesthesia provider: The major motivation for the use of regional anesthesia techniques — whether peripheral nerve blocks for surgery or continuous local anesthetic infusions for managing pain afterwards — is the improvements they bring to the patient's post-op experience. These improved outcomes result directly in efficiency gains, and time is money.

"The biggest risk of post-op complications in outpatient surgery is that the patient will be nauseated, they'll stay in PACU and take up space. Maybe they'll even have to be admitted. This costs money for patients and insurers," says David Rosen, MD, president of Midwest Anesthesia Partners of Naperville, Ill.

However, regional's post-op analgesic effects lower pain scores, which decreases the need for opioids, which cuts the risk of grogginess, nausea, vomiting, delirium, respiratory depression or other recovery-prolonging side effects, which speeds discharges. "For an outpatient facility, any technique that avoids the use of opioids is advantageous," says Mark E. Hudson, MD, MBA, associate professor of anesthesia at the University of Pittsburgh School of Medicine.

"Under regional, within minutes after surgery they're having 7-Up and crackers. In 20 to 25 minutes they're dressed. In 30 minutes, they're in a wheelchair, heading for the car," says Dr. Rosen. "Regional changes the culture of recovery."

Specifically, it can let your patients skip Phase 1 PACU. "There's no emergence time if a patient never has to wake up from anesthesia," says Eric Crabtree, MD, of Sheridan Healthcare, who directs anesthesia services at the Sanford-Bemidji Medical Center in Bemidji, Minn. "Going straight to Phase 2 recovery, that's several minutes of throughput time saved there."

Rules for a modern process
In fact, recovery criteria should be updated to accommodate changes in surgical anesthesia and facilitate accelerated discharges, says Brian A. Williams, MD, MBA, director of acute pain medicine, regional anesthesia, ambulatory anesthesia and pre-operative evaluation at the VA Pittsburgh HealthCare System. "Do what you can to jettison old criteria that don't address the details of modern anesthesia use," he says.

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