Regional anesthesia for outpatient surgery
| Autor: | Michael F. Mulroy, Susan B. McDonald |
|---|---|
| Rok vydání: | 2003 |
| Předmět: |
business.industry
Nausea Outpatient surgery Neuraxial blockade Nerve Block Catheterization Blockade Upper Extremity Alertness Anesthesiology and Pain Medicine Time frame Ambulatory Surgical Procedures Lower Extremity Anesthesia Conduction Regional anesthesia Anesthesia Vomiting Humans Medicine medicine.symptom business |
| Zdroj: | Anesthesiology Clinics of North America. 21:289-303 |
| ISSN: | 0889-8537 |
| Popis: | Outpatient surgery has gained steadily in the United States, both in total numbers of procedures performed and as a percentage of the overall surgical experience. Outpatient anesthesia requires a shift in our goals for the recovery of patients. Outpatients must be alert; free of pain, nausea, and vomiting; and able to ambulate to leave the unit successfully. Most outpatient surgical centers incorporate a high volume and rapid turnover setting, so that these goals must be achieved within a limited time frame. This represents a challenge for the anesthesiologist, who usually relies on opioids to provide comfort in the recovery room. In the outpatient setting, excessive reliance on these drugs can be associated with drowsiness and nausea, which can delay discharge and sometimes lead to unplanned overnight admission. Failure to provide adequate analgesia, however, is also a major source of unplanned admissions. This triad of pain, nausea, and vomiting is also the most frequent and most undesirable outcome as perceived by patients and anesthesiologists [1]. In this setting, regional anesthesia techniques offer significant advantages for outpatient surgery. The use of local infiltration provides excellent analgesia without the side effects of opioids. The performance of peripheral nerve block for upper and lower extremity surgery provides intraoperative anesthesia and prolonged postoperative analgesia. Some of these blocks, especially in the lower extremities, can provide up to 24 hours of postoperative analgesia. This advantage of peripheral blockade can be extended further with the use of continuous perineural catheters, which are capable of providing analgesia for as long as 72 hours after major extremity surgery. Neuraxial blockade can also be useful in the outpatient setting. Spinal and epidural anesthesia can provide a high degree of alertness for surgery and a low incidence of nausea. Neuraxial techniques, however, provide no postoperative analgesia, and careful attention must be paid to the choice of drug and dose to provide a sufficiently rapid return |
| Databáze: | OpenAIRE |
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