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Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study

Regional anesthesia (RA) is an anesthetic technique essential for the performance of ambulatory surgery. Failure rates range from 6% to 20%, and the consequences of these failures have been poorly investigated. We determined the incidence and the impact of regional block failure on patient managemen...

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Autores principales: Picard, Lucile, Belnou, Pierre, Debes, Claire, Lapidus, Nathanael, Sung Tsai, Eileen, Gaillard, Julien, Sautet, Alain, Bonnet, Francis, Lescot, Thomas, Verdonk, Franck
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463571/
https://www.ncbi.nlm.nih.gov/pubmed/32751880
http://dx.doi.org/10.3390/jcm9082453
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author Picard, Lucile
Belnou, Pierre
Debes, Claire
Lapidus, Nathanael
Sung Tsai, Eileen
Gaillard, Julien
Sautet, Alain
Bonnet, Francis
Lescot, Thomas
Verdonk, Franck
author_facet Picard, Lucile
Belnou, Pierre
Debes, Claire
Lapidus, Nathanael
Sung Tsai, Eileen
Gaillard, Julien
Sautet, Alain
Bonnet, Francis
Lescot, Thomas
Verdonk, Franck
author_sort Picard, Lucile
collection PubMed
description Regional anesthesia (RA) is an anesthetic technique essential for the performance of ambulatory surgery. Failure rates range from 6% to 20%, and the consequences of these failures have been poorly investigated. We determined the incidence and the impact of regional block failure on patient management in the ambulatory setting. This retrospective cohort study includes all adult patients who were admitted to a French University Hospital (Hôpital Saint-Antoine, AP-HP) between 1 January 2016 and 31 December 2017 for unplanned ambulatory distal upper limb surgery. Univariate and stepwise multivariate analyses were performed to determine factors associated with block failure. Among the 562 patients included, 48 (8.5%) had a block failure. RA failure was associated with a longer surgery duration (p = 0.02), more frequent intraoperative analgesics administration (p < 0.01), increased incidence of unplanned hospitalizations (p < 0.001), and a 39% prolongation of Post-Anesthesia Care Unit (PACU) length of stay (p < 0.0001). In the multivariate analysis, the risk factors associated with block failure were female sex (p = 0.04), an American Society of Anesthesiologists (ASA) score > 2 (p = 0.03), history of substance abuse (p = 0.01), and performance of the surgery outside of the specific ambulatory surgical unit (p = 0.01). Here, we have documented a significant incidence of block failure in ambulatory hand surgery, with impairment in the organization of care. Identifying patients at risk of failure could help improve their management, especially by focusing on providing care in a dedicated ambulatory circuit.
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spelling pubmed-74635712020-09-02 Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study Picard, Lucile Belnou, Pierre Debes, Claire Lapidus, Nathanael Sung Tsai, Eileen Gaillard, Julien Sautet, Alain Bonnet, Francis Lescot, Thomas Verdonk, Franck J Clin Med Article Regional anesthesia (RA) is an anesthetic technique essential for the performance of ambulatory surgery. Failure rates range from 6% to 20%, and the consequences of these failures have been poorly investigated. We determined the incidence and the impact of regional block failure on patient management in the ambulatory setting. This retrospective cohort study includes all adult patients who were admitted to a French University Hospital (Hôpital Saint-Antoine, AP-HP) between 1 January 2016 and 31 December 2017 for unplanned ambulatory distal upper limb surgery. Univariate and stepwise multivariate analyses were performed to determine factors associated with block failure. Among the 562 patients included, 48 (8.5%) had a block failure. RA failure was associated with a longer surgery duration (p = 0.02), more frequent intraoperative analgesics administration (p < 0.01), increased incidence of unplanned hospitalizations (p < 0.001), and a 39% prolongation of Post-Anesthesia Care Unit (PACU) length of stay (p < 0.0001). In the multivariate analysis, the risk factors associated with block failure were female sex (p = 0.04), an American Society of Anesthesiologists (ASA) score > 2 (p = 0.03), history of substance abuse (p = 0.01), and performance of the surgery outside of the specific ambulatory surgical unit (p = 0.01). Here, we have documented a significant incidence of block failure in ambulatory hand surgery, with impairment in the organization of care. Identifying patients at risk of failure could help improve their management, especially by focusing on providing care in a dedicated ambulatory circuit. MDPI 2020-07-31 /pmc/articles/PMC7463571/ /pubmed/32751880 http://dx.doi.org/10.3390/jcm9082453 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Picard, Lucile
Belnou, Pierre
Debes, Claire
Lapidus, Nathanael
Sung Tsai, Eileen
Gaillard, Julien
Sautet, Alain
Bonnet, Francis
Lescot, Thomas
Verdonk, Franck
Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study
title Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study
title_full Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study
title_fullStr Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study
title_full_unstemmed Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study
title_short Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study
title_sort impact of regional block failure in ambulatory hand surgery on patient management: a cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7463571/
https://www.ncbi.nlm.nih.gov/pubmed/32751880
http://dx.doi.org/10.3390/jcm9082453
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