Regional anesthesia has enjoyed a tremendous increase in popularity over the past decade. Studies have proven that it can shorten recovery times, decrease post-op pain, and allow patients to regain awareness and mobility sooner than with general anesthesia. In this article, I'll describe some of the newest research that proves the efficacy of regional anesthesia, share how regional anesthesia has made a difference in our facility, and provide some practical tips for incorporating it into yours.

The advantages of regional anesthesia
Increased safety. While anesthesia in general is extremely safe (the mortality rate is 1 in 250,000 cases), regional anesthesia makes it even safer. In a study published in the British Medical Journal in 2000, researchers compared 4,871 regional anesthesia cases with 4,688 general anesthesia cases. In patients who received spinal and epidural blocks, the chance of postoperative mortality and morbidity was one-third less than in the general anesthesia patients. These patients also had 44 percent less venous thromboembolism, 39 percent less pneumonia, and 59 percent less respiratory depression, as well as a reduced risk of myocardial infarction, bleeding complications, and renal failure, as compared to the general anesthesia patients.1 These findings suggested that regional could be dramatically safer for patients.

Less PONV. Studies show that twenty to thirty percent of all surgical patients experience some level of post-operative nausea and vomiting (PONV). In fact, PONV is one of the most important factors contributing to delay in patient discharge and increase in admissions after ambulatory surgery. PONV can lead to serious complications, such as aspiration, dehydration, increased anxiety, and dissatisfaction with the surgical experience. Regional anesthesia reduces the risk of PONV by avoiding exposure to nausea-provoking general anesthetics and narcotics. In fact, at our facility, we very rarely administer anti-emetics to patients receiving regional anesthesia.

Better pain control. Regional anesthesia also provides post-operative pain relief for as long as 18 hours after surgery. At our facility, patients who have regional rarely require narcotics until their blocks have worn off, which is usually hours after they have arrived at home. They can even pre-empt the pain by taking pain medication before the anesthesia wears off, allowing them to move around and start rehabilitation earlier.

Increased efficiency. Many doctors think administering regional anesthesia is a time-consuming process. It does take more time pre-operatively, but using regional anesthesia will actually make up that time and then some post-operatively. At our facility, patients who receive regional for minor procedures, like hand surgery, are able to go straight from the OR to the reclining area. There they rest for about 20-30 minutes before going home. Patients who require spinal or epidural blocks will typically spend only 15-20 minutes in our recovery area before being moved to the reclining area for another 30 minutes.

Less cost. A 1994 study performed at the Columbia University Medical Center found that using regional anesthesia could save facilities anywhere from about $30 to almost $65 dollars per case (see figure 1). Regional anesthetic drugs and equipment are both significantly less expensive than general anesthesia. A standard regional kit will cost about $15 to $25; whereas supplies for general anesthesia cost between $30 to $35. Regional drugs are also less, costing $20 to $45 per case, while general anesthesia drugs range from $35 to $65 per case. 2