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Can the choice of the local anesthetic have an impact on ambulatory surgery perioperative costs? Chloroprocaine for popliteal block in outpatient foot surgery


Saporito, A; Anselmi, L; Borgeat, A; Aguirre, J A (2016). Can the choice of the local anesthetic have an impact on ambulatory surgery perioperative costs? Chloroprocaine for popliteal block in outpatient foot surgery. Journal of clinical anesthesia, 32:119-126.

Abstract

STUDY OBJECTIVE: Short-acting regional anesthetics have already been successfully used for peripheral nerve blocks in an ambulatory surgery setting. However, the impact on direct and indirect perioperative costs comparing 2 different short-acting local anesthetics has not been performed yet.
DESIGN: Observational, prospective, case-control, cost-minimization study.
SETTING: Operating room, regional hospital
PATIENTS: One hundred adult American Society of Anesthesiologists status I-III patients scheduled for popliteal block after minor ambulatory foot surgery.
INTERVENTIONS: Application of 30 mL chloroprocaine 3% or of 30 mL mepivacaine 1.5% for anesthesia.
MEASUREMENTS: Cost-minimization evaluation. Direct and indirect perioperative costs were calculated. Block success, onset time and block duration, patient satisfaction, and unplanned outpatient visits or readmissions after discharge were also assessed.
MAIN RESULTS: Onset time (sensory: 4.3 ± 2.4 vs 11.5 ± 3.2 minutes; motor: 7.1 ± 3.7 vs 18.4 ± 4.5 minutes) and block duration (sensory: 105 ± 26 vs 317 ± 46 minutes; motor: 91 ± 25 vs 216 ± 31 minutes) were significantly shorter (P < .001) when chloroprocaine 3% was used. This translated to P < .001, basically due to a faster discharge home 55 ± 1 vs 175 ± 2 minutes; P < .001) in favor of chloroprocaine 3%, without negatively affecting either block efficacy or patients satisfaction. There were no unplanned outpatient visits or readmissions and no complications in the follow-up at 6 weeks.
CONCLUSIONS: We conclude that the more expensive chloroprocaine 3% for ambulatory foot surgery can reduce total perioperative costs and reduce length of stay in outpatient patients. Moreover, the saved time and personal resources could be used for additional cases, further increasing the revenues of an ambulatory surgical center.

Abstract

STUDY OBJECTIVE: Short-acting regional anesthetics have already been successfully used for peripheral nerve blocks in an ambulatory surgery setting. However, the impact on direct and indirect perioperative costs comparing 2 different short-acting local anesthetics has not been performed yet.
DESIGN: Observational, prospective, case-control, cost-minimization study.
SETTING: Operating room, regional hospital
PATIENTS: One hundred adult American Society of Anesthesiologists status I-III patients scheduled for popliteal block after minor ambulatory foot surgery.
INTERVENTIONS: Application of 30 mL chloroprocaine 3% or of 30 mL mepivacaine 1.5% for anesthesia.
MEASUREMENTS: Cost-minimization evaluation. Direct and indirect perioperative costs were calculated. Block success, onset time and block duration, patient satisfaction, and unplanned outpatient visits or readmissions after discharge were also assessed.
MAIN RESULTS: Onset time (sensory: 4.3 ± 2.4 vs 11.5 ± 3.2 minutes; motor: 7.1 ± 3.7 vs 18.4 ± 4.5 minutes) and block duration (sensory: 105 ± 26 vs 317 ± 46 minutes; motor: 91 ± 25 vs 216 ± 31 minutes) were significantly shorter (P < .001) when chloroprocaine 3% was used. This translated to P < .001, basically due to a faster discharge home 55 ± 1 vs 175 ± 2 minutes; P < .001) in favor of chloroprocaine 3%, without negatively affecting either block efficacy or patients satisfaction. There were no unplanned outpatient visits or readmissions and no complications in the follow-up at 6 weeks.
CONCLUSIONS: We conclude that the more expensive chloroprocaine 3% for ambulatory foot surgery can reduce total perioperative costs and reduce length of stay in outpatient patients. Moreover, the saved time and personal resources could be used for additional cases, further increasing the revenues of an ambulatory surgical center.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Balgrist University Hospital, Swiss Spinal Cord Injury Center
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:16 April 2016
Deposited On:02 Feb 2017 13:29
Last Modified:21 Nov 2017 19:00
Publisher:Elsevier
ISSN:0952-8180
Publisher DOI:https://doi.org/10.1016/j.jclinane.2016.02.017
PubMed ID:27290959

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