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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...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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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. |
format | Online Article Text |
id | pubmed-7463571 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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