Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Design and Patients
2.2. Patient Management
2.3. Study Outcomes
2.4. Regulatory and Ethical Aspects
2.5. Statistical Methodology
3. Results
3.1. Characteristics of the Study Population
3.2. Patient Management after Block Failure
3.3. Risk Factors Associated with Block Failure
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Bridenbaugh, L.D. Regional anaesthesia for outpatient surgery—A summary of 12 years’ experience. Can. Anaesth. Soc. J. 1983, 30, 548–552. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Richman, J.M.; Liu, S.S.; Courpas, G.; Wong, R.; Rowlingson, A.J.; McGready, J.; Cohen, S.R.; Wu, C.L. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth. Analg. 2006, 102, 248–257. [Google Scholar] [CrossRef] [PubMed]
- Liu, S.S.; Strodtbeck, W.M.; Richman, J.M.; Wu, C.L. A comparison of regional versus general anesthesia for ambulatory anesthesia: A meta-analysis of randomized controlled trials. Anesth. Analg. 2005, 101, 1634–1642. [Google Scholar] [CrossRef] [PubMed]
- MSS. Available online: https://solidarites-sante.gouv.fr/IMG/pdf/Abecedaire_chir_ambu.pdf (accessed on 9 February 2020).
- Cotter, J.T.; Nielsen, K.C.; Guller, U.; Steele, S.M.; Klein, S.M.; Greengras, R.A.; Pietrobon, R. Increased body mass index and ASA physical status IV are risk factors for block failure in ambulatory surgery—An analysis of 9,342 blocks. Can. J. Anesth. 2004, 51, 810–816. [Google Scholar] [CrossRef] [Green Version]
- Fanelli, G.; Casati, A.; Garancini, P.; Torri, G. Nerve stimulator and multiple injection technique for upper and lower limb blockade: Failure rate, patient acceptance, and neurologic complications. Anesth. Analg. 1999, 88, 847–852. [Google Scholar] [CrossRef]
- Carles, M.; Beloeil, H.; Bloc, S.; Nouette-Gaulain, K.; Aveline, C.; Cabaton, J.; Cuvillon, P.; Dadure, C.; Delaunay, L.; Estebe, J.P.; et al. Anesthésie loco-régionale périnerveuse (ALR-PN). Anesthésie et Réanim. 2019, 5, 208–217. [Google Scholar] [CrossRef]
- Gatra, A.; Barrou, L.; Mekki-Berrada, R.; Akallal, L.; Benaguida, M.; Komiha, A. Brachial plexus block and locoregional anesthesia of the upper limb. Apropos of 50 cases. Acta Chir. Belg. 1986, 86, 344–348. [Google Scholar]
- Weber, S.C.; Jain, R. Scalene regional anesthesia for shoulder surgery in a community setting: An assessment of risk. J. Bone Jt. Surg. Ser. A 2002, 84, 775–779. [Google Scholar] [CrossRef]
- Alfred, V.; Srinivasan, G.; Zachariah, M. Comparison of ultrasound with peripheral nerve stimulator guided technique for supraclavicular block in upper limb surgeries: A randomized controlled trial. Anesth. Essays Res. 2018, 12, 50. [Google Scholar] [CrossRef]
- Abrahams, M.S.; Aziz, M.F.; Fu, R.F.; Horn, J.-L. REGIONAL ANAESTHESIA Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: A systematic review and meta-analysis of randomized controlled trials. Br. J. Anaesth. 2009, 102, 408–417. [Google Scholar] [CrossRef] [Green Version]
- Ode, K.; Selvaraj, S.; Smith, A.F. Monitoring regional blockade. Anaesthesia 2017, 72, 70–75. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Toulouse, E.; Masseguin, C.; Lafont, B.; McGurk, G.; Harbonn, A.; Roberts, J.A.; Granier, S.; Dupeyron, A.; Bazin, J.E. French legal approach to clinical research. Anaesth. Crit. Care Pain Med. 2018, 37, 607–614. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Nofal, W.H.; El Fawal, S.M.; Shoukry, A.A.; Sabek, E.A.S.; Malak, W.F.A. Ultrasound-guided axillary brachial plexus block versus local infiltration anesthesia for arteriovenous fistula creation at the forearm for hemodialysis in patients with chronic renal failure. Saudi J. Anaesth. 2017, 11, 77–82. [Google Scholar] [CrossRef] [PubMed]
- Halvachizadeh, S.; Teuber, H.; Cinelli, P.; Allemann, F.; Pape, H.C.; Neuhaus, V. Does the time of day in orthopedic trauma surgery affect mortality and complication rates? Patient Saf. Surg. 2019, 13. [Google Scholar] [CrossRef] [PubMed]
- Cortegiani, A.; Gregoretti, C.; Neto, A.S.; Hemmes, S.N.T.; Ball, L.; Canet, J.; Hiesmayr, M.; Hollmann, M.W.; Mills, G.H.; Melo, M.F.V.; et al. Association between night-time surgery and occurrence of intraoperative adverse events and postoperative pulmonary complications. Br. J. Anaesth. 2019, 122, 361–369. [Google Scholar] [CrossRef] [Green Version]
- Uppal, V.; Sondekoppam, R.V.; Dhir, S.; Mackinnon, S.P.; Kwofie, M.K.; Retter, S.; Lopera, L.M.; Szerb, J.J.; McKeen, D.M. Association of obesity with failure of ultrasound-guided axillary brachial plexus block: A two-centre, prospective, observational, cohort study. Anaesthesia 2019. [Google Scholar] [CrossRef]
- Ross, H.E.; Glaser, F.B.; Germanson, T. The Prevalence of Psychiatric Disorders in Patients with Alcohol and Other Drug Problems. Arch. Gen. Psychiatry 1988, 45, 1023–1031. [Google Scholar] [CrossRef]
- Tan, S.Y. Cognitive and cognitive-behavioral methods for pain control: A selective review. Pain 1982, 12, 201–228. [Google Scholar] [CrossRef]
- McCaul, K.D.; Malott, J.M. Distraction and coping with pain. Psychol. Bull. 1984, 95, 516–533. [Google Scholar] [CrossRef]
- Alaterre, C.; Duceau, B.; Sung Tsai, E.; Zriouel, S.; Bonnet, F.; Lescot, T.; Verdonk, F. Virtual Reality for PEripheral Regional Anesthesia (VR-PERLA Study). J. Clin. Med. 2020, 9, 215. [Google Scholar] [CrossRef] [Green Version]
- Luyet, C.; Schüpfer, G.; Wipfli, M.; Greif, R.; Luginbühl, M.; Eichenberger, U. Different learning curves for axillary brachial plexus block: Ultrasound guidance versus nerve stimulation. Anesthesiol. Res. Pract. 2010, 2010. [Google Scholar] [CrossRef] [PubMed]
- Bishop, J.Y.; Sprague, M.; Gelber, J.; Krol, M.; Rosenblatt, M.A.; Gladstone, J.; Flatow, E.L. Interscalene regional anesthesia for shoulder surgery. J. Bone Joint Surg. Am. 2005, 87, 974–979. [Google Scholar] [CrossRef] [PubMed]
- Bailey, C.R.; Ahuja, M.; Bartholomew, K.; Bew, S.; Forbes, L.; Lipp, A.; Montgomery, J.; Russon, K.; Potparic, O.; Stocker, M. Guidelines for day-case surgery 2019. Anaesthesia 2019, 74, 778–792. [Google Scholar] [CrossRef] [PubMed]
- Bona, S.; Monzani, R.; Fumagalli Romario, U.; Zago, M.; Mariani, D.; Rosati, R. Outpatient laparoscopic cholecystectomy: A prospective study on 250 patients. Gastroenterol. Clin. Biol. 2007, 31, 1010–1015. [Google Scholar] [CrossRef]
Characteristic | Overall N = 562 (100%) | RA Success N = 514 (91.5%) | RA Failure N = 48 (8.5%) | p-Value a b | |
---|---|---|---|---|---|
Sex n (%) | Male | 350 (100%) | 327 (93.4%) | 23 (6.57%) | 0.04 |
Female | 212 (100%) | 187 (88.2%) | 25 (11.8%) | ||
Age (SD) | 41.3 (16.2) | 41.5 (16.1) | 38.9 (16.4) | 0.28 | |
ASA Score n (%) | ASA I | 404 (100%) | 376 (93%) | 28 (6.93%) | |
ASA II | 150 (100%) | 131 (87.3%) | 19 (12.7%) | 0.03 | |
ASA III | 8 (100%) | 7 (87.5%) | 1 (12.5%) | ||
ASA IV | 0 (0%) | 0 (0%) | 0 (0%) | ||
Substance abuse n (%) | 6 (100%) | 3 (50%) | 3 (50%) | <0.001 | |
Depressive syndrome n (%) | 23 (100%) | 20 (86.9%) | 3 (13.1%) | 0.44 | |
Chronic analgesic treatment n (%) | 19 (100%) | 17 (89.5%) | 2 (10.5%) | 0.67 | |
Diagnosis before surgery, n (%) | Whitlow | 370 (100%) | 341 (92.2%) | 29 (7.8%) | |
Door finger | 89 (100%) | 77 (86.5%) | 12 (13.5%) | 0.20 | |
Wound | 103 (100%) | 96 (93.2%) | 7 (6.8%) | ||
Surgical area, n (%) | Ambulatory surgical unit | 321 (100%) | 302 (94.1%) | 19 (5.9%) | 0.01 |
Conventional surgical unit | 241 (100%) | 212 (88%) | 29 (12%) | ||
Anesthetist, n (%) | Resident | 418 (100%) | 385 (92.1%) | 33 (7.9%) | |
Fellow | 44 (100%) | 37 (84.1%) | 7 (145.9%) | 0.21 | |
Assistant Professor | 100 (100%) | 92 (92%) | 8 (8%) | ||
Average waiting time before RA, min (SD) | 55.2 (60.8) | 56.6 (61) | 40.4 (57.3) | 0.09 | |
Block type, n (%) | Axillary block | 275 (100%) | 252 (91.7%) | 23 (8.3%) | |
Truncular block | 99 (100%) | 89 (89.9%) | 10 (10.2%) | 0.61 | |
Digital block | 20 (100%) | 20 100%) | 0 (0%) | ||
AxB + truncular blocks | 168 (100%) | 153 (91.1%) | 15 (8.9%) | ||
Local anesthetic n (%) | Lidocaine | 297 (100%) | 274 (92.3%) | 23 (7.7%) | |
Ropivacaine | 87 (100%) | 77 (88.5%) | 10 (11.5%) | 0.51 | |
Both | 178 (100%) | 163 (91.7%) | 15 (8.3%) | ||
Average time between RA and surgery, min (SD) | 41.3 (35.5) | 41.1 (34.2) | 43.6 (47.8) | 0.34 | |
Period of the day | Night | 45 (100%) | 39 (86.7%) | 6 (13.3%) | 0.09 |
Morning | 357 (100%) | 333 (93.3%) | 24 (6.7%) | ||
Afternoon | 160 (100%) | 142 (88.8%) | 18 (11.2%) |
Variable | RA Success N = 514 (91.5%) | RA Failure N = 48 (8.5%) | p-Value a b |
---|---|---|---|
Average surgery time, min (SD) | 26.6 (18.7) | 35.5 (28.9) | 0.02 |
Intraoperative analgesics (acetaminophen or nefopam), n (%) | 18 (3.5%) | 7 (14.6%) | <0.01 |
PONV, n (%) | 3 (0.58%) | 1 (2.08%) | 0.30 |
Analgesics after surgery, n (%) | 114 (22.2%) | 11 (22.9%) | 0.86 |
Average duration in recovery room, min (SD) | 32.5 (19.3) | 45.1 (26,4) | <0.01 |
Hospitalization, n (%) | 22 (4.28%) | 8 (16.7%) | <0.01 |
Period of Surgery | Hospitalizations | p | |
---|---|---|---|
No (n = 531) | Yes (n = 30) | ||
Morning (8 a.m. to 12 p.m.) n (%) | 355 (67%) | 1 (3%) | |
Afternoon (12 p.m. to 6 p.m.) n (%) | 155 (29%) | 5 (17%) | p < 0.0001 |
Night (6 p.m. to 8 a.m.) n (%) | 21 (4%) | 24 (80%) |
Variable | OR | IC 95% | p-Value |
---|---|---|---|
Sex: female | 2.35 | 1.24–4.45 | 0.01 |
Conventional surgery unit | 2.33 | 1.25–4.34 | 0.01 |
Substance abuse | 7.27 | 1.18–44.88 | 0.03 |
ASA score | 2.02 | 1.01–3.94 | 0.04 |
© 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/).
Share and Cite
Picard, L.; Belnou, P.; Debes, C.; Lapidus, N.; Sung Tsai, E.; Gaillard, J.; Sautet, A.; Bonnet, F.; Lescot, T.; Verdonk, F. Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study. J. Clin. Med. 2020, 9, 2453. https://doi.org/10.3390/jcm9082453
Picard L, Belnou P, Debes C, Lapidus N, Sung Tsai E, Gaillard J, Sautet A, Bonnet F, Lescot T, Verdonk F. Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study. Journal of Clinical Medicine. 2020; 9(8):2453. https://doi.org/10.3390/jcm9082453
Chicago/Turabian StylePicard, Lucile, Pierre Belnou, Claire Debes, Nathanael Lapidus, Eileen Sung Tsai, Julien Gaillard, Alain Sautet, Francis Bonnet, Thomas Lescot, and Franck Verdonk. 2020. "Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study" Journal of Clinical Medicine 9, no. 8: 2453. https://doi.org/10.3390/jcm9082453