To the Editor:
Most anesthesiologists believe that the cost of ultrasound (US)-guided nerve blocks is prohibitive. We compared the costs of infraclavicular block administered by nerve stimulator and US-guided techniques. The cost of equipment and supplies (ES) to our hospital is listed in Table 1 for both techniques (1–3). The cost of Sonosite™ 180 US device with C11 probe is $17,000. If 5,000 blocks are performed with this device, the average cost is $3.40 per block.
The drapes, Betadine, gauze, marking pen, lidocaine, initial sedation, and other supplies cost the same for both techniques.
The cost of ES for nerve stimulator technique without catheter technique ($10.80) is nearly same as that of US-guided technique ($9.60). For catheter technique, the B Braun 18 G Contiplex® needle and catheter costs $33.50, whereas the ES for US technique costs $20.60, saving $13.90 per case.
The imaging and drug injections take 1 to 2 min to perform with US guidance, and the average onset of anesthesia is 6 min. With the nerve stimulator, obtaining appropriate twitches to a current of ≤0.5 mA and injection take 7 to 9 min, and the average onset of block is 22 min (2,3). Cost of the OR time that is usually calculated at $8 /min results in a difference of $168. This would amount to $840,000 for 5,000 blocks. Performing blocks outside OR requires additional cost for space, personnel, and extra monitors. Accurate drug delivery to individual nerves with US is likely to reduce the rate of incomplete or patchy block, which require propofol sedation or general anesthesia, with potential reduction in cost (this has not been taken into account while calculating the above costs). The real-time observation of spread of local anesthetic around nerves by US imaging minimizes intravascular injection and nerve injuries, improving patient safety and decreasing costs of potential litigation. In addition, the US device can be used for central venous/arterial line placements.
In summary, the decreased OR time requirement for the US technique results in significant cost reduction, with or without placement of catheter. The cost of ES is comparable for two techniques without catheter placement; however with catheter placement US guidance saves additional $ 13.90 per case in ES.
NavParkash S. Sandhu, MS, MD
Deepal S. Sidhu, MD
Levon M. Capan, MD
References
1. Sandhu NS, Capan LM. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth 2002; 89: 254–9.
2. Gaertner E, Estebe JP, Zamfir A, et al. Infraclavicular plexus block: multiple injections versus single injection. Reg Anesth Pain Med 2002; 27: 590–4.
3. Borgeat A, Ekatodramis G, Dumont C. An evaluation of the infraclavicular block via a modified approach of the Raj technique. Anesth Analg 2001; 93: 436–41.
