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Setting up an ambulatory regional anesthesia program for orthopedic surgery requires a multidisciplinary approach among anesthesiologists, surgeons, and nurses with all aspects of perioperative care considered.
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Regional anesthesia has distinct advantages in the orthopedic population by optimizing pain control and minimizing postoperative nausea and vomiting.
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To provide effective regional anesthesia, anesthesiologists need to consider a streamlined approach whereby peripheral nerve blocks can be
Setting Up an Ambulatory Regional Anesthesia Program for Orthopedic Surgery
Section snippets
Key points
Regional Anesthesia Optimizes Analgesia
Regional anesthesia allows site-specific anesthesia and analgesia, reducing and possibly eliminating the need for perioperative opioids and their related side effects. Local anesthetics have been shown to decrease postoperative pain.2 Multiple meta-analyses have established that regional anesthesia provides better quality analgesia than systemic opioids. Continuous perineural local anesthetic infusions can improve analgesia for up to 48 hours after surgery compared with opioids.3, 4, 5 Compared
Patient Education and Screening
Setting up expectations and goals for patients is critical to the success of an ambulatory regional anesthesia service. Preoperative counseling allows the patient to seek further information and clarify questions ahead of time. Thorough preoperative education can expedite block placement on the day of surgery and minimize unnecessary stress for patients by allowing them to be better educated and more informed. Patients who were surveyed about their experiences after a peripheral nerve block
Postoperative considerations for ambulatory perineural catheters
Ambulatory perineural catheters merit special considerations. Patients need to understand how to care for the insertion site, including the common possibility that the catheter may have some leakage. Patients need to understand that catheters can become inadvertently dislodged and be prepared for a backup pain management plan. Some practices allow patients to remove their own catheters if they are comfortable doing so.25 No catheter should be removed while the limb is still insensate; if
Future considerations
Setting up an ambulatory regional anesthesia program for orthopedic surgery can provide optimal perioperative anesthesia and analgesia, and can lead to greater patient satisfaction. With skilled practitioners and a streamlined system, efficiency can be preserved and even improved with faster PACU discharge. Future avenues in ambulatory regional anesthesia may include the development of newer techniques to extend the duration of analgesia provided by peripheral nerve blockade without unwanted
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