Obstetric Postanesthesia Care Unit Stays: Reevaluation of Discharge Criteria After Regional Anesthesia

Prophylactic Ondansetron for the Prevention of Intrathecal Fentanyl- or Sufentanil-Mediated Pruritus

“…However, pruritus is an unwanted side effect of intrathecal opioid administration that can decrease patient satisfaction with anesthesia, 16 delay postanesthesia care unit discharge, and increase costs. 17 The incidence of intrathecal opioid-related pruritus ranges from 30% to 100%, 18 depending on the intrathecal opioid used and the patient population.Among the many medications that have been studied to prevent intrathecal opioid-associated pruritus, 18 5-HT3 receptor antagonists have a low toxicity profile with no risk of respiratory depression or effect on coagulation. Although a meta-analysis by Bonnet et al,19 in 2008, failed to demonstrate an effect of 5-HT3 receptor antagonists on intrathecal opioid-induced pruritus, the study primarily focused on intrathecal morphine and pooled studies of different 5-HT3 receptor antagonists at different doses.…”

“…However, pruritus is an unwanted side effect of intrathecal opioid administration that can decrease patient satisfaction with anesthesia, 16 delay postanesthesia care unit discharge, and increase costs. 17 The incidence of intrathecal opioid-related pruritus ranges from 30% to 100%, 18 depending on the intrathecal opioid used and the patient population.…”

Effects of Adding Intrathecal Epinephrine to Spinal Anesthesia on Anesthesia-Related Cesarean Delivery Outcomes: Should We Reconsider Its Use?

“…Unlike discharge following ambulatory anesthesia, complete recovery of motor function is not necessarily an expectation post-cesarean delivery [ 1 , 9 ]. The time course and recovery characteristics in the obstetric PACU also differ from those of the post-surgical PACU.…”

“…Discharge from obstetric PACU typically requires evidence of spinal block resolution, such as two dermatome regression of sensory block or lower extremity movement. Increased PACU LOS due to epinephrine use could result in increased variable costs and reduced efficacy of resource utilization, personnel allocation, and lower patient satisfaction metrics [9]. Prior studies examining the addition of epinephrine to bupivacaine for spinal anesthesia for repeat cesarean delivery have primarily evaluated block onset, quality, and duration of the motor or sensory blockade but have not examined the effect on PACU LOS [8,[10][11][12].…”

Subarachnoid Block With Hyperbaric Bupivacaine and Morphine May Shorten PACU Stay After Cesarean Delivery

“…3,4,8,9,11,12 Shortening postanesthesia care unit (PACU) stay after cesarean delivery may improve patient satisfaction 14 and reduce costs. 15 An anesthetic strategy aimed at maximizing hemodynamic stability, lowering postoperative nausea and vomiting (PONV) incidence, 15 and minimizing residual motor block 16 and postoperative analgesic requirements may be advantageous to the patient and significantly shorten PACU stay after cesarean delivery. An intrathecal drug combination that will enable shortening the PACU stay while decreasing adverse effects was sought.…”