NYSORA Journal

The Use of Regional Anesthesia in Ambulatory Anesthesia Practice Results of a National Survey

Based on: "Hadzic A,Vloka JD, Kuroda MM, Koorn R, Birnbach DJ. The use of peripheral nerve blocks in anesthesia practice. A national survey. Reg Anesth Pain Med 1998:23:241-246".

There is increasing evidence that regional anesthesia and peripheral nerve blocks may result in a favorable recovery profile, reduced cost and excellent patient satisfaction. While a recent study indicated that regional anesthesia accounts for 20% of clinical anesthesiology practice in the US, the extent to which regional anesthesia and specifically, peripheral nerve blocks are used in out-patients is not known.

Thus, in order to ascertain the use of peripheral nerve blocks in ambulatory anesthesia practice, a questionnaire on the use of neuraxial anesthesia and peripheral nerve blocks was sent to 805 randomly selected anesthesiologists practicing in the US. The final data analysis included only respondents who reported participating in the care of ambulatory patients. Four hundred-nine valid responses were received (response rate of 50.8%). Of these, 382 (94.6%) reported participa-ting in the care of ambulatory patients, and nearly half of respondents (45.2%) reported that out-patient anesthesia comprised more than 50% of their practice. The most commonly used regional anesthesia techniques were IV regional anesthesia, brachial plexus block and neuraxial anesthesia.

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Legend: Horizontal bars represent percentage of anesthesiologists who use the technique in their ambulatory anesthesia practice.
* Hadzic A, Vloka JD, Koorn R, Sanborn K, Shih H, Birnbach DJ. The use of regional anesthesia in ambulatory anesthesia practice. Results of a national survey. Anesthesiology 1997; 3A:A22.

The least frequently used were lower extremity peripheral nerve blocks. While peripheral nerve blocks were more frequently utilized in teaching institutions (p<0.05), there were no significant regional differences (West Coast vs. Mid-West vs. East Coast). Most anesthesiologists felt that the use in peripheral nerve blocks would either increase (43.5%) or remain the same (50.5%) in the future, whereas few (5.5%) felt that it would decrease.

Despite the frequently debated disadvantages of spinal and epidural anesthesia in the outpatient setting (risks of post-dural puncture headache, delayed recovery, etc.), 70% of responding anesthesiologists reported using neuraxial anesthesia in ambulatory patients. While peripheral nerve blocks offer many potential advantages in ambulatory patients, and many anesthesiologists feel that their use will increase in the future, a vast majority of anesthesiologists do not perform lower extremity peripheral nerve blocks. A possible contributing factor to infrequent use of lower extremity blocks could be the inadequate exposure to these techniques during anesthesia training, as reported by 47.7% of respondents. Thus, it remains important that organized anesthesia societies (ASA, ASRA, SAMBA) continue to offer regional anesthesia workshops that also focus on less frequently used peripheral nerve blocks techniques.

References
  1. Hadzic A, Vloka JD, Koorn R, Sanborn K, Shih H, Birnbach DJ. The use of regional anesthesia in ambulatory anesthesia practice. Results of a national survey. Anesthesiology 1997; 3A:A22

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