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Short-acting regional anesthetics have already been successfully used for peripheral nerve blocks in an ambulatory surgery setting. However, the impact on direct and indirect perioperative costs comparing 2 different short-acting local anesthetics has not been performed yet. Observational, prospective, case-control, cost-minimization study. Operating room, regional hospital One hundred adult American Society of Anesthesiologists status I-III patients scheduled for popliteal block after minor ambulatory foot surgery. Application of 30 mL chloroprocaine 3% or of 30 mL mepivacaine 1.5% for anesthesia. Cost-minimization evaluation. Direct and indirect perioperative costs were calculated. Block success, onset time and block duration, patient satisfaction, and unplanned outpatient visits or readmissions after discharge were also assessed. Onset time (sensory: 4.3 ± 2.4 vs 11.5 ± 3.2 minutes; motor: 7.1 ± 3.7 vs 18.4 ± 4.5 minutes) and block duration (sensory: 105 ± 26 vs 317 ± 46 minutes; motor: 91 ± 25 vs 216 ± 31 minutes) were significantly shorter (P < .001) when chloroprocaine 3% was used. This translated to P < .001, basically due to a faster discharge home 55 ± 1 vs 175 ± 2 minutes; P < .001) in favor of chloroprocaine 3%, without negatively affecting either block efficacy or patients satisfaction. There were no unplanned outpatient visits or readmissions and no complications in the follow-up at 6 weeks. We conclude that the more expensive chloroprocaine 3% for ambulatory foot surgery can reduce total perioperative costs and reduce length of stay in outpatient patients. Moreover, the saved time and personal resources could be used for additional cases, further increasing the revenues of an ambulatory surgical center. •Cost reduction is an extremely hot topic in perioperative medicine.•A faster discharge is associated to fix cost reduction and increased turnover in ambulatory surgery.•A case-control cost-minimization study to compare chloroprocaine with mepivacaine for outpatient popliteal block was performed.•Chloroprocaine was shown to be as effective as mepivacaine but was associated with a reduction in total costs.

Background Preperitoneal catheter analgesia following abdominal surgery has attracted interest in the last decade. We conducted this study to evaluate the benefits of preperitoneal catheter analgesia in managing pain after abdominal colon and rectal resections. Methods A total of 50 patients undergoing colon and rectal resections for benign and malignant diseases received analgesic medicines via an epidural catheter placed just prior to surgery and a preperitoneal catheter placed at the end of the surgical procedure. Patients were instructed to use the epidural patient-controlled analgesia (PCA) device freely and were randomized into two groups after obtaining the approval of the Institutional Review Board: Group A received 10 ml of levobupivacaine twice a day postoperatively via preperitoneal catheter and group B received only 10 ml of saline. Demographics, surgical characteristics, pain scores recorded four days following surgery, analgesic volume used from the epidural PCA, clinical outcomes (length of stay, time to first bowel movement, time to first passage of gas or stool, time to first oral intake) and respiratory function test results (preoperative vs. postoperative) were compared. Results There were no significant differences in demographics or surgical characteristics between both groups. Pain scores were similar. Clinical outcomes and respiratory functions were comparable. The use of analgesic volume via epidural catheter was significantly lower in group A than in group B ( P  = 0.032). Conclusions Preperitoneal catheter analgesia significantly decreased the need for epidural drug consumption and proved to be a beneficial adjunct for postoperative pain management of patients who underwent colon and rectal resections.

Background Understanding the financial and environmental impact of clinical pathways is important for designing sustainable services. This study aimed to compare the cost and carbon footprint of sub-Tenon’s and topical anaesthesia for cataract surgery, benchmark minimum topical anaesthesia utilisation rates, and quantify the benefits of increased topical anaesthesia usage in the United Kingdom National Health Service (NHS). Methods The cost and carbon footprint of products and staffing for topical and sub-Tenon’s anaesthesia for cataract surgery were calculated and applied to National Ophthalmology Database audit data. A mainly process-based approach was used to estimate the carbon dioxide equivalent (CO2e) of product production, usage, and waste disposal. Results The typical CO2e per case was 0.71 kg for topical anaesthesia and 1.19 kg for sub-Tenon’s anaesthesia. Around a third of CO2e was generated by usage of unneccesary equiptment and wasteful practices. The typical cost per case was £14.60–£17.14 for topical anaesthesia, £27.74 for sub-Tenon’s anaesthesia performed by an operating department practitioner and £56.15 for sub-Tenon’s anaesthesia performed by a consultant anaesthetist. It is estimated that around 25,000 NHS cataract cases could annually be converted from sub-Tenon’s to topical anaesthesia, which would reduce the CO2e emissions of services by 12,000 kg while saving £265,000 on product usage and between £63,500 and £773,750 on staffing. Conclusions Topical anaesthesia is a cheaper and more environmentally sustainable alternative to sub-Tenon’s anaesthesia for cataract surgery. Increased topical anaesthesia usage in cataract services could contribute towards the NHS aspiration of becoming “net zero” by 2040.

To evaluate the cost and time effectiveness for different anesthesia methods when performing knee arthroscopy, this study compared three different anesthesia methods. Four hundred healthy patients scheduled for knee arthroscopy were randomized to either local anesthesia (LA) ( n =200), spinal anesthesia (SA) ( n =100) or general anesthesia (GA) ( n =100). The LA arthroscopies were performed in a facility set up in our outpatient department without anesthesia service. The SA and GA arthroscopies were performed in our central operating department with full anesthesia service. Comparisons were made between total hospital stay, anesthesia time, surgery time, recovery time, pharmaceutical and total cost. The total hospital time was 130.4 min (SD 35.14, range 63–383) in the LA group compared to 280.4 min (SD 79.29, range 155–589) in the GA group ( p <0.001). The total hospital time in the GA group was also shorter than that of 350.3 min (SD 65.37, range 198–502) in the SA group ( p <0.001). The time from start of anesthesia to start of surgery was significantly longer in the LA group, 39.2 min (SD 13.13, range 17–87), compared to 20.1 min (SD 4.93, range 11–35) in the SA group and to 17.6 min (SD 4.64, range 9–44) in the GA group. There were no differences in the surgery time for the three groups. The use of LA was shown to save SEK 1011 (Swedish Crowns) per patient compared to SA and GA.

Wide-awake local anesthesia no tourniquet (WALANT) surgery offers a unique clinical and economic approach to delivering high-quality upper extremity care. This article explores the evoluation, techniques, clinical efficancy, financial advantages, and future directions of WALANT as it establishes is growing role in value-based orthopedic care. In doing so, it outlines the value proposition of WALANT for patients, providers, and the hospital system. The authors conducted a comprehensive PubMed search to identify studies evaluating the clinical and economic outcomes of WALANT surgery in upper extremity procedures. Eligible studies included prospective and retrospective research, as well as case studies and case series, comparing WALANT with traditional anesthesia. The studies examined focused on metrics such as functional outcomes, patient satisfaction, and cost savings for the patient and the hospital system. Current literature shows that hand and upper extremity surgery performed under WALANT yields similar functional outcomes and even demonstrates equal or higher patient satisfaction compared with traditional anesthesia. Regarding cost savings, WALANT's minimalist approach to procedures can lead to significant waste reduction and notable financial benefits for the patient, the provider, the hospital, and the wider healthcare system. WALANT surgery offers a compelling value proposition for the patient, the provider, and the healthcare system at large. Through efficient use of resources focused on minimizing waste and optimizing patient experience and outcomes, WALANT offers an opportunity for value-based surgical care. Further research into more sophisticated clinical uses and large-scale cost-savings analyses is necessary for WALANT procedures to be further validated and more broadly adopted. Level V.

Purpose Office-based transnasal flexible endoscopic surgery under topical anesthesia has recently been developed as an alternative for transoral laryngopharyngeal surgery under general anesthesia. The aim of this study was to evaluate differences in health care costs between the two surgical settings. Methods PubMed, EMBASE and Cochrane Library were searched for studies reporting on costs of laryngopharyngeal procedures that could either be performed in the office or operating room (i.e., laser surgery, biopsies, vocal fold injection, or hypopharyngeal or esophageal dilation). Quality assessment of the included references was performed. Results Of 2953 identified studies, 13 were included. Quality assessment revealed that methodology differed significantly among the included studies. All studies reported lower costs for procedures performed in the office compared to those performed in the operating room. The variation within reported hospital and physician charges was substantial. Conclusion Office-based laryngopharyngeal procedures under topical anesthesia result in lower costs compared to similar procedures performed under general anesthesia.

To evaluate two anesthetic techniques, namely, local anesthesia with sedation, and spinal anesthesia, with respect to recovery times, postoperative side effects, pain scores, patient satisfaction, and hospital costs for ambulatory pilonidal disease surgery. Prospective, randomized study. University Hospital of Pamukkale. 60 consenting patients scheduled for pilonidal disease operation with Limberg flap technique. Patients were randomly allocated into two groups: Group 1 (n = 30) received spinal anesthesia with hyperbaric bupivacaine 1.5 mL 0.5%, and Group 2 (n = 30) received local infiltration with a 50-mL mixture containing 10 mL bupivacaine 0.5%, 10 mL prilocaine HCl 2%, and 30 mL isotonic solution with 1:200 000 epinephrine in combination with intravenous (IV) midazolam sedation. Perioperative and postoperative side effects, patient satisfaction, preoperative visual analog scale (VAS) pain scores, and VAS scores from the fourth hour postoperatively until the seventh day were assessed. Anesthesia, operation, surgery, and total hospital time, and costs (drug, resources, and labor) were recorded. No difference was found between groups in the frequency of side effects. Urinary retention was diagnosed in two patients in the spinal anesthesia group. There was no statistical significant difference seen in satisfaction scores between groups. No statistical significance in VAS pain scores between groups was noted except for the fourth postoperative hour values. The average time spent in the operating room (OR) was greater in the spinal anesthesia group. All Group 2 patients achieved fast-tracking criteria in the OR and were able to bypass the postanesthesia care unit (PACU). Total hospital time and total cost were significantly higher in the spinal anesthesia group than local anesthesia-sedation group (p < 0.05). The use of local anesthesia-sedation for ambulatory anorectal surgery resulted in a shorter hospital time, lower hospital costs, and no side effects compared with spinal anesthesia.

Study design: Prospective, open label, cross-over-designed clinical study. Objective: To evaluate the effectiveness of an instillation of lidocaine into the bladder with versus without electromotive drug administration (EMDA) to anesthetize the bladder before botulinum-A toxin injections. Setting: Neurourology, Swiss Paraplegic Center, Balgrist University Hospital, Zurich, Switzerland. Methods: In all, 28 patients with severe neurogenic detrusor overactivity but preserved bladder sensibility were treated with botulinum-A toxin injections into the detrusor muscle. A measure of 300 u of botulinum-A toxin (Botox ® ) was injected at 30 sites sparing the trigone. Prior to the injection, the bladder was anesthesized with conventional lidocaine instillation in a group of 10 patients and with lidocaine instillation enhanced by EMDA in 28 patients. The patients scored the injection pain on a 10-point rating scale. Pain rating scores with versus without EMDA enhancement of the lidocaine instillation were analyzed and the costs of the EMDA procedure were compared to general/spinal anesthesia. Results: The mean pain score of the 10 patients who underwent the injections of Botox ® after conventional lidocaine instillation was 4.0 (SD 1.6). Following EMDA enhanced lidocaine instillation slight even or no pain occurred during the injections of Botox ® , and the mean pain score was 0.5 (SD 0.2). Compared to spinal or general anesthesia, the local anesthesia saved around 15% of the costs. Conclusions: EMDA enhanced instillation of lidocaine enables a sufficient anesthesia of the bladder wall that ensures a painless application of the botulinum-A toxin injections into the detrusor muscle. This method may avoid general or spinal anesthesia in patients with preserved bladder sensibility. It ensures considerable cost reduction, avoids anesthesia-related risks and complications and enables the procedure on an outpatient basis.

Introduction The Wide-Awake-Local-Anesthesia-No-Tourniquet (WALANT) technique is being used progressively more and more in hand surgery as it avoids tourniquet-related complications and saves money. Materials and methods In the present study, we analyzed our cases of carpal tunnel syndrome or trigger finger operated upon with this technique from January 1, 2018 to December 31, 2022. Results We obtained 822 cases (426 carpal tunnel syndrome, 396 trigger finger) with an overall anesthesiologic efficacy (no need of additional anesthetic) of 97.8%. Patients were satisfied or very satisfied with the anesthetic choice in 99.8% of cases. Conclusions We believe WALANT to be a safe and effective technique that every hand surgeon should have in his/her repertoire.

Regional anesthesia offers an alternative to general anesthesia and may be advantageous in low resource environments. There is a paucity of data regarding the practice of regional anesthesia in low- and middle-income countries. Using access data from a free Android app with curated regional anesthesia learning modules, we aimed to estimate global interest in regional anesthesia and potential applications to clinical practice stratified by World Bank income level. We retrospectively analyzed data collected from the free Android app \"Anesthesiologist\" from December 2015 to April 2020. The app performs basic anesthetic calculations and provides links to videos on performing 12 different nerve blocks. Users of the app were classified on the basis of whether or not they had accessed the links. Nerve blocks were also classified according to major use (surgical block, postoperative pain adjunct, rescue block). Practitioners in low- and middle-income countries accessed the app more frequently than in high-income countries as measured by clicks. Users from low- and middle-income countries focused mainly on surgical blocks: ankle, axillary, infraclavicular, interscalene, and supraclavicular blocks. In high-income countries, more users viewed postoperative pain blocks: adductor canal, popliteal, femoral, and transverse abdominis plane blocks. Utilization of the app was constant over time with a general decline with the start of the COVID-19 pandemic. The use of an in app survey and analytics can help identify gaps and opportunities for regional anesthesia techniques and practices. This is especially impactful in limited-resource areas, such as lower-income environments and can lead to targeted educational initiatives.