Regional anesthesia for acute pain management in the outpatient setting
Ambulatory surgery includes procedures following which, the patients are discharged from a health care facility within 23 hours. Advances in minimally invasive surgical technique have contributed to the frequency of outpatient procedures. Institutional fiscal pressures have further promoted a reduction in patient length of stay. Perioperative patient care has evolved to meet the needs of the outpatient. Ambulatory anesthesia incorporates techniques that provide rapid emergence and return to preoperative function but that also provide effective postoperative analgesia with minimal side effects. Regional anesthesia and local anesthetic based techniques provide postoperative analgesia to the surgical site, minimize the requirement for opioid analgesia and reduce the risk of opioid-related side effects. This chapter outlines the application of peripheral nerve blocks as well as the use of wound infiltration of local anesthetic for postoperative analgesia in outpatients. Patient Selection For Ambulatory Regional Anesthesia And Analgesia: A comprehensive preoperative assessment is performed for all patients scheduled for ambulatory surgery. Prior to planning ambulatory regional anesthesia for postoperative analgesia, both the surgical procedure and the patient are evaluated as to their suitability for this modality of pain control. The planned analgesic modality must provide comprehensive pain control for the anticipated surgical insult. For example, a superficial wound catheter may be insufficient for surgery that also involves extensive deep dissection of painful structures. Single injection peripheral nerve block or wound infiltration is considered for surgical procedures with mild to moderate postoperative pain (ie, knee arthroscopy), whereas continuous catheter techniques are applicable for procedures with significant postoperative pain (ie, shoulder rotator cuff repair).
