6 - "Fast-track" patients to Phase II recovery and decrease PACU duration in Ambulatory Arthroscopic Shoulder Surgery with combined peripheral nerve block and monitored anesthesia care

2019 ◽  
Author(s):  
Nuala Treanor ◽  
Virginia Vezina ◽  
Dr. Anne Lui
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Phase Ii ◽  
Fast Track ◽  
Peripheral Nerve Block ◽  
Shoulder Surgery ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Arthroscopic Shoulder Surgery

scholarly journals Persistent Postoperative Opioid Prescription Fulfillment and Peripheral Nerve Blocks for Ambulatory Shoulder Surgery: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Gavin M. Hamilton ◽  
Sarah Tierney ◽  
Reva Ramlogan ◽  
Colin J. L. McCartney ◽  
Lisa A. Bromley ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Peripheral Nerve Block ◽  
Oral Morphine ◽  
Shoulder Surgery ◽  
Opioid Prescription ◽  
Oral Morphine Equivalent ◽  
Morphine Equivalent

Background There is need to identify perioperative interventions that decrease chronic opioid use. The authors hypothesized that receipt of a peripheral nerve block would be associated with a lower incidence of persistent postoperative opioid prescription fulfillment. Methods This was a retrospective population-based cohort study examining ambulatory shoulder surgery patients in Ontario, Canada. The main outcome measure was persistent postoperative opioid prescription fulfillment. In opioid-naive patients (no opioid prescription fulfillment in 90 days preoperatively), this was present if an individual fulfilled an opioid prescription of at least a 60-day supply during postoperative days 90 to 365. In opioid-exposed (less than 60 mg oral morphine equivalent dose per day within 90 days preoperatively) or opioid-tolerant (60 mg oral morphine equivalent dose per day or above within 90 days preoperatively) patients, this was classified as present if an individual experienced any increase in opioid prescription fulfillment from postoperative day 90 to 365 relative to their baseline use before surgery. The authors’ exposure was the receipt of a peripheral nerve block. Results The authors identified 48,523 people who underwent elective shoulder surgery from July 1, 2012, to December 31, 2017, at one of 118 Ontario hospitals. There were 8,229 (17%) patients who had persistent postoperative opioid prescription fulfillment. Of those who received a peripheral nerve block, 5,008 (16%) went on to persistent postoperative opioid prescription fulfillment compared to 3,221 (18%) patients who did not (adjusted odds ratio, 0.90; 95% CI, 0.83 to 0.97; P = 0.007). This statistically significant observation was not reproduced in a coarsened exact matching sensitivity analysis (adjusted odds ratio, 0.85; 95% CI, 0.71 to 1.02; P = 0.087) or several other subgroup and sensitivity analyses. Conclusions This retrospective analysis found no association between receipt of a peripheral nerve block and a lower incidence of persistent postoperative opioid prescription fulfillment in ambulatory shoulder surgery patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Chart Review of PACU Outcomes for Patients Who Had Ambulatory Shoulder Surgery with Peripheral Nerve Block (PNB) and General Anesthesia Compared to General Anesthesia (GA)

2015 ◽  
Vol 05 (07) ◽  
pp. 173-176
Author(s):  
Dennis E. Feierman ◽  
Eliezer Klinkowitz ◽  
Charles Keilin ◽  
Mark Kronenfeld ◽  
David Rahmani ◽  
...  
Keyword(s):  
Peripheral Nerve ◽  
General Anesthesia ◽  
Nerve Block ◽  
Chart Review ◽  
Peripheral Nerve Block ◽  
Shoulder Surgery

scholarly journals Factors associated with low levels of patient satisfaction following peripheral nerve block

2021 ◽  
pp. 0310057X2097240
Author(s):  
Anthony D Hade ◽  
Satomi Okano ◽  
Anita Pelecanos ◽  
Adrian Chin
Keyword(s):  
Patient Satisfaction ◽  
Peripheral Nerve ◽  
Nerve Block ◽  
Peripheral Nerve Block ◽  
Moderate Intensity ◽  
Post Anaesthesia Care Unit ◽  
Negatively Associated ◽  
Factors Associated ◽  
Low Levels ◽  
Anaesthesia Care

Peripheral nerve blocks can provide surgical anaesthesia as well as excellent postoperative analgesia. When questioned postoperatively, however, some patients report low levels of satisfaction with their nerve block experience. At our hospital, patients undergoing regional anaesthesia have their patient characteristics, block characteristics and postoperative feedback routinely recorded in a block registry. We analysed data from 979 consecutive patients undergoing peripheral nerve block for orthopaedic surgery to identify factors associated with low levels of patient satisfaction. The primary outcome was patient satisfaction with their peripheral nerve block (scale 1–5: 4–5 is ‘satisfied’, 1–3 is ‘not satisfied’). Eighty-nine percent (871/979) of patients reported being ‘satisfied’ with their block. Factors negatively associated with patient satisfaction were rebound pain (adjusted odds ratio (aOR) 0.19, 95% confidence interval (CI) 0.04 to 0.85 for moderate rebound pain; aOR 0.11, 95% CI 0.03 to 0.48 for severe rebound pain), discomfort during the block (aOR 0.37, 95% CI 0.16 to 0.82 for moderate discomfort; aOR 0.19, 95% CI 0.05 to 0.76 for severe discomfort) and pain in the post-anaesthesia care unit (aOR 0.30, 95% CI 0.17 to 0.55 for pain ≥8/10). Only 24% (26/108) of patients who reported being ‘not satisfied’ stated that they would be unwilling to undergo a hypothetical future nerve block. Rebound pain of at least moderate intensity, procedural discomfort of at least moderate intensity and severe pain in the post-anaesthesia care unit are all negatively associated with patient satisfaction. Of these factors, rebound pain occurs most frequently, being present in 52% (403/777) of our respondents.

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