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Use of Regional Anesthesia for Outpatient Surgery Within the United States: A Prevalence Study Using a Nationwide Database

Gabriel, Rodney A. MD; Ilfeld, Brian M. MD, MS (Clinical Investigation)
doi: 10.1213/ANE.0000000000002503
Research Report: PDF Only

BACKGROUND:

Regional anesthesia is of benefit for outpatient surgery given its demonstrated improvement in analgesia and decrease in complications, resulting in shorter average recovery room times and lower hospital readmission rates. Unfortunately, there are few epidemiological studies outlining the overall utilization of peripheral nerve blocks (PNBs) in this setting. Therefore, the primary objective of this study was to report the overall utilization of several types of PNBs among all candidate cases in the outpatient setting within the United States.

METHODS:

We identified all cases from the National Anesthesia Clinical Outcomes Registry that were performed as an outpatient surgery. We reported the frequency of various types of PNBs among all candidate cases, defined as cases that potentially could have received a PNB. Changes in prevalence of PNB utilization from 2010 to 2015 were analyzed by using logistic regression.

RESULTS:

Of the 12,911,056 outpatient surgeries in the National Anesthesia Clinical Outcomes Registry, 3,297,372 (25.5%) were amenable to a PNB. However, the overall PNB frequency was only 3.3% of the possible cases. The overall utilization for PNB of the brachial plexus, sciatic nerve, and femoral nerve were 6.1%, 1.5%, and 1.9%, respectively. The surgical procedures generating the highest volume of PNBs were shoulder arthroscopies and anterior cruciate ligament reconstruction, in which 41% and 32% received a PNB, respectively. During this time period, there was a significant increase in overall PNB utilization for both single-injection and continuous PNB (P < .0001). However, the proportion of continuous PNB to single-injection PNB did not increase significantly.

CONCLUSIONS:

While the overall frequency of PNB is relatively low, there was a significant increase in its prevalence during the study period. Regional anesthesia offers significant positive impact for perioperative outcomes and hospital efficiency metrics; however, it is not clear what is limiting its widespread use. Future studies are necessary to identify barriers and disparities in care to implement methods to increase regional anesthesia volume nationwide where beneficial and appropriate.

Accepted for publication August 23, 2017.

Funding: Financial support from National Library of Medicine (NLM) training grant number T15LM011271.

Conflicts of Interest: See Disclosures at the end of the article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.anesthesia-analgesia.org).

Implications Statement: We report the use of regional anesthesia in outpatient surgeries using nationwide data. This analysis looks at all cases amenable to nerve blocks and reports the overall frequency of various common nerve blocks. Furthermore, annual trends in utilization of regional anesthesia (single-injection and continuous infusions via catheters) are reported.

Reprints will not be available from the authors.

Address correspondence to Rodney A. Gabriel, MD, Department of Anesthesiology, University of California, San Diego, 9500 Gilman Dr, MC 0881, La Jolla, CA 92093. Address e-mail to ragabriel@ucsd.edu.

© 2017 International Anesthesia Research Society

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