Regional Anesthesia, Time to Hospital Discharge, and In-Hospital Mortality

Bulka, Catherine M.; Shotwell, Matthew S.; Gupta, Rajnish K.; Sandberg, Warren S.; Ehrenfeld, Jesse M.

doi:10.1097/aap.0000000000000121

Cited by 35 publications

(21 citation statements)

References 30 publications

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“…Untreated pain can lead to increased patient stress and dissatisfaction, in addition to other cardiopulmonary complications and slower recovery. 1,2 There are many approaches to pain control after abdominal and colorectal surgeries. Epidural analgesia is associated with a shorter duration of postoperative ileus, attenuation of stress response, fewer pulmonary complications, and improved postoperative pain control and recovery.…”

Section: Discussionmentioning

confidence: 99%

“…Uncontrolled postoperative pain increases the incidence of postoperative complications. 1,2 Multimodal analgesia can improve pain control in the postoperative period and reduces complications that may arise from using a single mode of analgesia. For example, reliance on opioid analgesia increases the incidence of adverse effects of opioids including pruritus, nausea, and vomiting, as well as respiratory depression.…”

mentioning

confidence: 99%

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Bilateral Continuous Quadratus Lumborum Block for Acute Postoperative Abdominal Pain as a Rescue After Opioid-Induced Respiratory Depression

et al. 2015

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We present a case of acute postoperative abdominal pain after proctosigmoidectomy and colorectal anastomosis that was treated by bilateral continuous quadratus lumborum block. The block was performed in the lateral position under ultrasound guidance with a 15-mL bolus of 0.5% bupivacaine injected anterior to the quadratus lumborum muscle followed by bilateral catheter placement. Each catheter received a continuous infusion of 0.1% bupivacaine at 8 mL/h and an on-demand bolus 5 mL every 30 minutes. Sensory level was confirmed by insensitivity to cold from T7 through T12. The block was devoid of hemodynamic side effects or motor weakness. This case demonstrates that bilateral continuous quadratus lumborum catheters can provide extended postoperative pain control.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Bilateral Continuous Quadratus Lumborum Block for Acute Postoperative Abdominal Pain as a Rescue After Opioid-Induced Respiratory Depression

et al. 2015

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“…35–43 The patient was the unit of analysis. Patient outcomes are correlated within surgeons that are, in turn, correlated within hospitals.…”

Section: Methodsmentioning

confidence: 99%

The Effect of Anesthetic Type on Outcomes of Hip Fracture Surgery

2016

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Hip fractures are a global public health problem. During surgery following hip fractures, both general and regional anesthesia are used, but which type of anesthesia offers a better outcome remains controversial. There has been little research evaluating different anesthetic types on mortality and readmission rates for hip fracture surgery using nationwide population-based data.We used nationwide population-based data to examine the effect of anesthetic type on mortality and readmission rates for hip fracture surgery.Retrospective observational study.General acute care hospitals throughout Taiwan.A total of 17,189 patients hospitalized for hip fracture surgery in 2011.Generalized estimating equation models with propensity score weighting were performed after adjustment for patient, surgeon, and hospital characteristics to examine the associations of anesthesia type with 30-day all-cause mortality, 30-day all-cause readmission, and 30-day specific-cause readmission (including surgical site infection, sepsis, acute respiratory failure, acute stroke, acute myocardial infarction, acute renal failure, deep vein thrombosis, pneumonia, and urinary tract infection).Of 17,189 patients, 11,153 (64.9%) received regional anesthesia and 6036 (35.1%) received general anesthesia. Overall, the 30-day mortality rate was 1.7%, and the 30-day readmission rate was 12.3%. Regional anesthesia was not associated with decreased 30-day all-cause mortality (odds ratio [OR] 0.89, 95% confidence interval [CI] 0.67–1.18, P = 0.409), but associated with decreased 30-day all-cause readmission and surgical site infection readmission relative to general anesthesia (OR 0.83, 95% CI 0.75–0.93, P = 0.001 and OR 0.69, 95% CI 0.49–0.97, P = 0.031).Regional anesthesia is not associated with 30-day mortality, but is associated with lower 30-day all-cause and surgical site infection readmission compared with general anesthesia for hip fracture surgery.

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“…We fully agree with that and would like to add that a FIC block may even be performed for analgesia after hip fractures by emergency medical service nurses at home before transport of the patient to the hospital. After appropriate training and clear instructions, emergency medical service nurses could perform the FIC block effectively as described by Dochez et al 2 This could provide effective analgesia beyond evacuation of the accident scene, allowing more comfortable transfers between stretchers and hospital beds and even facilitating positioning before spinal anesthesia. For patient safety reasons, in the Dochez et al feasibility study, lidocaine 0.3 mL/kg (10 mg/mL) with adrenaline 5 μg/mL was injected prehospitally.…”

Section: Fascia Iliaca Compartmentmentioning

confidence: 99%