Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery
Abstract
:1. Introduction
2. Methods
2.1. Study Design and Population
2.2. Data Collection
2.3. Primary and Secondary Outcomes
2.4. Statistical Methods
2.5. Propensity Score Analysis
2.6. Legal Requirements
3. Results
3.1. Propensity-Score Based Matching
3.2. Multivariable Analysis
4. Discussion
Strengths and Limits
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
ABPB | Axillary Brachial Plexus Block |
ASA | American Society of Anesthesiologists |
BMI | Body Mass Index |
IV | Intravenous |
MAC | Monitored Anesthesia Care |
NB | Negative Binomial |
PACU | Post-anesthesia Care Unit |
References
- O’Donnell, B.D.; Ryan, H.; O’Sullivan, O.; Iohom, G. Ultrasound-guided axillary brachial plexus block with 20 milliliters local anesthetic mixture versus general anesthesia for upper limb trauma surgery: An observer-blinded, prospective, randomized, controlled trial. Anesth. Analg. 2009, 109, 279–283. [Google Scholar] [CrossRef]
- Chan, V.W.S.; Peng, P.W.H.; Kaszas, Z.; Middleton, W.J.; Muni, R.; Anastakis, D.G.; Graham, B.A. A comparative study of general anesthesia, intravenous regional anesthesia, and axillary block for outpatient hand surgery: Clinical outcome and cost analysis. Anesth. Analg. 2001, 93, 1181–1184. [Google Scholar] [CrossRef] [Green Version]
- Carles, A.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) Expert panel guidelines on perineural anesthesia. Anesth. Réanim. 2019, 5, 208–217. [Google Scholar] [CrossRef]
- Abrahams, B.M.S.; Aziz, M.F.; Fu, R.F.; Horn, J.-L. 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] [PubMed] [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. Study Group on Regional Anesthesia. Anesth. Analg. 1999, 88, 847–852. [Google Scholar] [CrossRef] [PubMed]
- Hole, J.; Hirsch, M.; Ball, E.; Meads, C. Music as an aid for postoperative recovery in adults: A systematic review and meta-analysis. Lancet 2015, 386, 1659–1671. [Google Scholar] [CrossRef]
- Bradt, J.; Dileo, C.; Shim, M. Music interventions for preoperative anxiety. Cochrane Database Syst. Rev. 2013, 6, CD006908. [Google Scholar] [CrossRef] [PubMed]
- Prescilla, R.; Mason, K.P. Recent advances and contributions to procedural sedation with considerations for the future. Minerva Anestesiol. 2014, 80, 844–855. [Google Scholar]
- Tobias, J.D.; Leder, M. Procedural sedation: A review of sedative agents, monitoring, and management of complications. Saudi J Anaesth. 2011, 5, 395–410. [Google Scholar] [CrossRef]
- Memtsoudis, S.G.; Cozowicz, C.; Nagappa, M.; Wong, J.; Joshi, G.P.; Wong, D.T.; Doufas, A.G.; Yilmaz, M.; Stein, M.H.; Krajewski, M.L.; et al. Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea. Anesth. Analg. 2018, 127, 967–987. [Google Scholar] [CrossRef]
- Kristensen, S.D.; Knuuti, J. New ESC/ESA Guidelines on non-cardiac surgery: Cardiovascular assessment and management. Eur. Heart J. 2014, 35, 2344–2345. [Google Scholar] [CrossRef] [PubMed]
- Ekstein, M.; Gavish, D.; Ezri, T.; Weinbroum, A.A. Monitored anaesthesia care in the elderly: Guidelines and recommendations. Drugs Aging 2008, 25, 477–500. [Google Scholar] [CrossRef] [PubMed]
- Apfelbaum, J.; Gross, J.; Connis, R.; Agarkar, M.; Arnold, D.; Coté, C.; Tung, A. Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology 2018, 128, 437–479. [Google Scholar]
- Fredman, B.; Lahav, M.; Zohar, E.; Golod, M.; Paruta, I.; Jedeikin, R. The effect of midazolam premedication on mental and psychomotor recovery in geriatric patients undergoing brief surgical procedures. Anesth. Analg. 1999, 89, 1161–1166. [Google Scholar] [CrossRef]
- Magazzeni, P.; Jochum, D.; Iohom, G.; Mekler, G.; Albuisson, E.; Bouaziz, H. Ultrasound-Guided Selective Versus Conventional Block of the Medial Brachial Cutaneous and the Intercostobrachial Nerves. Reg. Anesth. Acute Pain 2018, 43, 1. [Google Scholar] [CrossRef]
- Bhananker, S.M.; Posner, K.L.; Cheney, F.W.; Caplan, R.A.; Lee, L.A.; Domino, K.B. Injury and liability associated with monitored anesthesia care: A closed claims analysis. Anesthesiology 2006, 104, 228–234. [Google Scholar] [CrossRef]
- Wakai, A.; Blackburn, C.; McCabe, A.; Reece, E.; O’Connor, G.; Glasheen, J.; Staunton, P.; Cronin, J.; Sampson, C.; McCoy, S.C.; et al. The use of propofol for procedural sedation in emergency departments. Cochrane Database Syst Rev 2015, 2015, CD007399. [Google Scholar] [CrossRef]
- Zhang, R.; Lu, Q.; Wu, Y. The Comparison of Midazolam and Propofol in Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis. Surg. Laparosc. Endosc. Percutan. Tech. 2018, 28, 153–158. [Google Scholar] [CrossRef]
- King, B. Patient satisfaction survey: Day surgery unit. Aust. Clin. Rev. 1989, 9, 127–129. [Google Scholar]
- Burkle, C.M.; Mann, C.E.; Steege, J.R.; Stokke, J.S.; Jacob, A.K.; Pasternak, J.J. Patient fear of anesthesia complications according to surgical type: Potential impact on informed consent for anesthesia. Acta Anaesthesiol. Scand. 2014, 58, 1249–1257. [Google Scholar] [CrossRef]
- Blumer, S.; Peretz, B.; Zisman, G.; Ratson, T. Effect of Sedation with Midazolam and Time to Discharge among Pediatric Dental Patients. J. Clin. Pediatr. Dent. 2017, 41, 384–387. [Google Scholar] [CrossRef] [PubMed]
- Journal officiel de la République Française n°0252 du 31 Octobre 2018. Décret n° 2018-934 du 29 octobre 2018 relatif à la surveillance post-interventionnelle et à la visite pré-anesthésique. Available online: https://www.legifrance.gouv.fr/loda/id/JORFTEXT000037542346/ (accessed on 1 February 2022).
- Dolkart, O.; Amar, E.; Weisman, D.; Flaishon, R.; Weinbroum, A. Patient dissatisfaction following prolonged stay in the post-anesthesia care unit due to unavailable ward bed in a tertiary hospital. Harefuah 2013, 152, 446–550, 500. [Google Scholar] [PubMed]
- Bourgeois, E.; Cousin, A.; Chatel, C.; Gentili, M.E. Are pain and PONV so predominant in ambulatory surgery: Survey of call on D1 in 11,104 patients? Anaesth. Crit. Care Pain Med. 2017, 36, 193–194. [Google Scholar] [CrossRef] [PubMed]
- Lipira, A.B.; Sood, R.F.; Tatman, P.D.; Davis, J.I.; Morrison, S.D.; Ko, J.H. Complications Within 30 Days of Hand Surgery: An Analysis of 10,646 Patients. J. Hand Surg. Am. 2015, 40, 1852–1859 e3. [Google Scholar] [CrossRef]
- Hinkelbein, J.; Genzwuerker, H.V.; Fiedler, F. Detection of a systolic pressure threshold for reliable readings in pulse oximetry. Resuscitation 2005, 64, 315–319. [Google Scholar] [CrossRef]
- Wu, C.L.; Naqibuddin, M.; Fleisher, L.A. Measurement of patient satisfaction as an outcome of regional anesthesia and analgesia: A systematic review. Reg. Anesth. Pain. Med. 2001, 26, 196–208. [Google Scholar] [CrossRef]
- Maurice-Szamburski, A.; Bruder, N.; Loundou, A.; Capdevila, X.; Auquier, P. Development and validation of a perioperative satisfaction questionnaire in regional anesthesia. Anesthiology 2013, 118, 78–87. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tyser, A.R.; Gaffney, C.J.; Zhang, C.; Presson, A.P. The Association of Patient Satisfaction with Pain, Anxiety, and Self-Reported Physical Function. J. Bone Joint Surg. Am. 2018, 100, 1811–1818. [Google Scholar] [CrossRef]
Characteristics | Sedated Group | Non-Sedated Group | p-Value | Unadjusted OR [95%CI] | Total |
---|---|---|---|---|---|
Number of patients | 501 (22%) | 1817 (78%) | 2318 (100%) | ||
Sex | 0.077 | 0.835 [0.684 to 1.019] | |||
Male | 276 (55%) | 1081 (60%) | 1357 (59%) | ||
Female | 225 (45%) | 736 (40%) | 961 (41%) | ||
Age (years), mean (SD) | 49 (17) | 50 (17) | 0.052 | ||
Height (cm), mean (SD) | 169 (9) | 170 (9) | 0.232 | ||
Weight (kg), mean (SD) | 75 (17) | 76 (16) | 0.269 | ||
BMI (kg/m2), mean (SD) | 26 (5) | 26 (5) | 0.504 | ||
ASA | 0.285 | ||||
1 | 307 (61%) | 1038 (57%) | 1345 (58%) | ||
2 | 162 (33%) | 638 (35%) | 800 (35%) | ||
3 | 31 (6%) | 137 (8%) | 168 (7%) | ||
Hypertension | 0.129 | 0.827 [0.647 to 1.057] | |||
Yes | 99 (20%) | 417 (23%) | 516 (22%) | ||
No | 402 (80%) | 1400 (77%) | 1802 (78%) | ||
Anti-hypertensive medication | 0.099 | 0.809 [0.630 to 1.040] | |||
Yes | 93 (19%) | 403 (22%) | 496 (21%) | ||
No | 408 (81%) | 1413 (78%) | 1821 (79%) | ||
Beta-blockers | 0.19 | 0.781 [0.539 to 1.131] | |||
Yes | 37 (7%) | 170 (9%) | 207 (9%) | ||
No | 464 (93%) | 1646 (91%) | 2110 (91%) | ||
Chronic respiratory disease | 0.009 | 0.579 [0.388 to 0.864] | |||
Yes | 30 (6%) | 180 (10%) | 210 (9%) | ||
No | 471 (94%) | 1637 (90%) | 2108 (91%) | ||
Smoking | <0.0001 | 0.511 [0.355 to 0.737] | |||
Yes | 36 (7%) | 239 (13%) | 275 (12%) | ||
No | 465 (93%) | 1582 (87%) | 2043 (88%) | ||
Reason for hospitalization | 0.451 | 1.079 [0.885 to 1.316] | |||
Emergency surgery | 249 (50%) | 858 (47%) | 1107 (48%) | ||
Planned surgery | 252 (50%) | 957 (53%) | 1209 (52%) | ||
Operation site | 0.64 | 1.047 [0.859 to 1.278] | |||
Right | 250 (50%) | 926 (51%) | 1176 (51%) | ||
Left | 250 (50%) | 884 (49%) | 1134 (49%) | ||
Local anesthetic | 0.056 | 1.221 [0.994 to 1.501] | |||
Mepivacaine | 322 (64%) | 1077 (59%) | 1399 (60%) | ||
Ropivacaine | 179 (36%) | 735 (41%) | 914 (40%) | ||
Premedication | <0.0001 | 1.658 [1.317 to 2.088] | |||
Yes | 136 (28%) | 337 (19%) | 473 (20%) | ||
No | 357 (72%) | 1467 (81%) | 1824 (80%) | ||
Music | 0.003 | 0.649 [0.490 to 0.861] | |||
Yes | 67 (13%) | 349 (19%) | 416 (18%) | ||
No | 434 (87%) | 1468 (81%) | 1902 (82%) | ||
Type of sedation | |||||
Midazolam | 418 (83%) | 0 (0%) | 418 (83%) | ||
Multiple | 83 (17%) | 0 (0%) | 83 (17%) | ||
Oxygen | <0.0001 | 17.193 [7.058 to 41.882] | |||
Yes | 27 (5%) | 6 (0.3%) | 33 (1%) | ||
No | 474 (95%) | 1811 (99.7%) | 2285 (99%) | ||
Mean systolic BP (mmHg), mean (SD) | 130 (17) | 133 (16) | 0.001 | ||
Mean diastolic BP (mmHg), mean (SD) | 78 (10) | 78 (10) | 0.571 | ||
Mean pulse oximetry (%), mean (SD) | 96 (2) | 96 (2) | 0.189 | ||
Number of desaturations, median (Q1–Q3) | 3 (1 to 17) | 1 (0 to 7) | <0.0001 | ||
Mean heart rate (bpm), mean (SD) | 72 (12) | 70 (11) | 0.019 | ||
Satisfaction in recovery room | 0.049 | ||||
10 | 210 (60.2%) | 914 (67.0%) | 1127 (65.7%) | ||
9 | 93 (26.6%) | 309 (22.7%) | 402 (23.4%) | ||
≤8 | 46 (13.2%) | 140 (10.3%) | 187 (10.9%) | ||
Time in operating room (minutes), median (Q1–Q3) | 97 (74 to 129) | 95 (69 to 128) | 0.26 | ||
Time in recovery room (minutes), median (Q1–Q3) | 38 (25 to 56) | 30 (18 to 47) | <0.0001 | ||
Total time spent on site (minutes), median (Q1–Q3) | 148 (120 to 189) | 138 (108 to 177) | <0.0001 |
Day 1 Follow-Up | Sedated Group | Non-Sedated Group | p-Value | Unadjusted OR [95%CI] | Total |
---|---|---|---|---|---|
Answered call on day 1 | 0.405 | 0.902 [0.707 to 1.150] | |||
Yes | 146 (29%) | 506 (28%) | 652 (28%) | ||
No | 200 (40%) | 625 (34%) | 825 (36%) | ||
Pain on day 1 | 0.006 | 2.005 [1.222 to 3.291] | |||
Yes | 29 (23%) | 59 (13%) | 88 (15%) | ||
No | 100 (77%) | 408 (87%) | 508 (85%) | ||
Pain the first night | 0.205 | 1.308 [0.863 to 1.983] | |||
Yes | 44 (34%) | 131 (28%) | 175 (29%) | ||
No | 86 (66%) | 335 (72%) | 421 (71%) | ||
Pain medication taken | 0.065 | 1.477 [0.976 to 2.233] | |||
Yes | 107 (74%) | 328 (66%) | 435 (67%) | ||
No | 38 (26%) | 172 (34%) | 210 (33%) | ||
Nausea/Vomiting | 0.799 | 1.161 [0.369 to 3.655] | |||
Yes | 4 (3%) | 12 (2%) | 16 (2%) | ||
No | 141 (97%) | 491 (98%) | 632 (98%) | ||
Food intake | 0.157 | 1.624 [0.829 to 3.179] | |||
Yes | 135 (93%) | 446 (88%) | 581 (89%) | ||
No | 11(7%) | 59 (12%) | 70 (11%) | ||
Fever | 0.113 | 7 [0.630 to 77.750] | |||
Yes | 2 (1%) | 1 (0.2%) | 3 (1%) | ||
No | 144 (99%) | 504 (99.8%) | 648 (99%) | ||
Bleeding | 0.692 | 1.396 [0.268 to 7.270] | |||
Yes | 2 (1%) | 5 (1%) | 7 (1%) | ||
No | 143 (99%) | 499 (99%) | 642 (99%) | ||
Treatment compliance | 0.055 | 1.872 [0.896 to 3.553] | |||
Yes | 132 (92%) | 429 (86%) | 561 (87%) | ||
No | 12 (8%) | 73 (134%) | 85 (13%) | ||
Dyssomnia | 0.775 | 1.162 [0.415 to 3.253] | |||
Yes | 5 (3%) | 15 (3%) | 20 (3%) | ||
No | 140 (97%) | 488 (97%) | 628 (97%) |
Variable | No Sedation | Sedation | P-Value after Matching | Standardized Mean Difference (SMD) after Matching | Standardized Mean Difference (SMD) before Matching |
---|---|---|---|---|---|
n | 195 | 195 | |||
Anesthetist, n (%) | 0.96 | 0.10 | 1.83 | ||
Anesthetist 1 | 23 (11.8) | 32 (16.4) | |||
Anesthetist 2 | 41 (21.0) | 39 (20.0) | |||
Anesthetist 3 | 38 (19.5) | 40 (20.5) | |||
Anesthetist 4 | 31 (15.9) | 32 (16.4) | |||
Anesthetist 5 | 30 (15.4) | 23 (11.8) | |||
Anesthetist 6 | 32 (16.4) | 29 (14.9) | |||
Surgeon, n (%) | 0.75 | 0.17 | 0.10 | ||
Surgeon 1 | 23 (11.8) | 23 (11.8) | |||
Surgeon 2 | 9 (4.6) | 6 (3.1) | |||
Surgeon 3 | 24 (12.3) | 24 (12.3) | |||
Surgeon 4 | 32 (16.4) | 29 (14.9) | |||
Surgeon 5 | 75 (38.5) | 78 (40.0) | |||
Surgeon 6 | 32 (16.4) | 35 (17.9) | |||
Respiratory disease, n (%) | 18 (9.2) | 9 (4.6) | 0.07 | 0.18 | 0.14 |
Age: mean (SD) | 49.95 ± 18.06 | 47.82 ± 16.23 | 0.22 | 0.12 | 0.09 |
Sex (male), n (%) | 96 (49.2) | 86 (44.1) | 0.31 | 0.10 | 0.11 |
ASA score, n (%) | 0.99 | 0.00 | 0.06 | ||
ASA1 | 117 (60.0) | 117 (60.0) | |||
ASA2 | 65 (33.3) | 65 (33.3) | |||
ASA3 | 13 (6.7) | 13 (6.7) | |||
BMI, mean (SD) | 25.70 ± 5.02 | 25.64 ± 4.96 | 0.91 | 0.01 | 0.04 |
Variable | RR [95%CI] | p-Value (Univariate Analysis) | aRR [95%CI] | p-Value (Multivariable Analysis) |
---|---|---|---|---|
Sedation | 1.383 [1.141 to 1.678] | <0.0001 | 1.534 [1.283 to 1.836] | <0.0001 |
ASA score | <0.0001 | 0.97 | ||
ASA 1 | 1 [Reference] | 1 [Reference] | ||
ASA 2 | 1.238 [0.873 to 1.718] | 0.992 [0.714 to 1.362] | ||
ASA 3 | 1.657 [1.050 to 2.908] | 1.051 [0.670 to 1.763] | ||
Age (1 unit increase) | 1.055 [1.043 to 1.067] | <0.0001 | 1.045 [1.031 to 1.059] | <0.0001 |
Sex: Male (Reference = female) | 1.103 [0.908 to 1.342] | 0.32 | 1.292 [1.076 to 1.551] | 0.01 |
Time in operating room | 1.002 [0.998 to 1.006] | 0.45 | 1.003 [0.999 to 1.007] | 0.12 |
Emergency surgery | 0.768 [0.634 to 0.961] | 0.002 | 0.765 [0.622 to 0.939] | 0.01 |
Respiratory disease | 0.991 [0.663 to 1.480] | 0.37 | 0.937 [0.632 to 1.451] | 0.76 |
BMI (1 unit increase) | 1.126 [1.079 to 1.175] | <0.0001 | 1.086 [1.046 to 1.129] | <0.0001 |
High blood pressure | 1.879 [1.523 to 2.363] | <0.001 | 1.108 [0.798 to 1.555] | 0.54 |
Beta blocker | 1.685 [1.243 to 2.283] | 0.02 | 0.879 [0.608 to 1.288] | 0.50 |
Anesthetist | 0.93 | 0.12 | ||
Anesthetist 1 | 1 [Reference] | 1 [Reference] | ||
Anesthetist 2 | 0.913 [0.425 to 2.474] | 0.601 [0.294 to 1.417] | ||
Anesthetist 3 | 0.968 [0.593 to 1.677] | 0.879 [0.570 to 1.409] | ||
Anesthetist 4 | 0.995 [0.632 to 1.632] | 0.786 [0.509 to 1.240] | ||
Anesthetist 5 | 1.096 [0.768 to 1.561] | 1.310 [0.935 to 1.832] | ||
Anesthetist 6 | 1.243 [0.800 to 1.999] | 1.043 [0.696 to 1.593] | ||
Surgeon | 0.52 | 0.57 | ||
Surgeon 1 | 1 [Reference] | 1 [Reference] | ||
Surgeon 2 | 0.930 [0.633 to 1.416] | 1.123 [0.784 to 1.645] | ||
Surgeon 3 | 1.219 [0.828 to 1.864] | 1.336 [0.913 to 1.993] | ||
Surgeon 4 | 0.878 [0.578 to 1.401] | 0.823 [0.557 to 1.251] | ||
Surgeon 5 | 0.719 [0.461 to 1.194] | 0.993 [0.647 to 1.576] | ||
Surgeon 6 | 1.013 [0.664 to 1.627] | 1.045 [0.676 to 1.663] |
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Sanchez, A.; Chrusciel, J.; Cimino, Y.; Nguyen, M.; Guinot, P.-G.; Sanchez, S.; Bouhemad, B. Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery. Healthcare 2022, 10, 313. https://doi.org/10.3390/healthcare10020313
Sanchez A, Chrusciel J, Cimino Y, Nguyen M, Guinot P-G, Sanchez S, Bouhemad B. Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery. Healthcare. 2022; 10(2):313. https://doi.org/10.3390/healthcare10020313
Chicago/Turabian StyleSanchez, Antoine, Jan Chrusciel, Yann Cimino, Maxime Nguyen, Pierre-Grégoire Guinot, Stéphane Sanchez, and Belaid Bouhemad. 2022. "Evaluation of Monitored Anesthesia Care Involving Sedation and Axillary Nerve Block for Day-Case Hand Surgery" Healthcare 10, no. 2: 313. https://doi.org/10.3390/healthcare10020313