Journal Article

Can the choice of the local anesthetic have an impact on ambulatory surgery perioperative costs? Chloroprocaine for popliteal block in outpatient foot surgery

Borgeat, Alain, Anselmi, Luciano, Aguirre, José A., Saporito, Andrea

2016

Overview

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.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Ambulatory anesthesia / Ambulatory care / Ambulatory Surgical Procedures - economics / Ambulatory Surgical Procedures - methods / Anesthesia / Anesthesia, Local - economics / Anesthetics, Local - economics / Bone surgery / Case-Control Studies / Cost analysis / Cost control / Female / Foot - surgery / Health Care Costs - statistics & numerical data / Hospital costs / Humans / Local anesthesia / Male / Mepivacaine - economics / Middle Aged / Nerve Block - economics / Nerve Block - methods / Orthopedic Procedures - economics / Orthopedic Procedures - methods / Outpatients / Pain / Pain Medicine / Patient satisfaction / Perioperative Care - economics / Procaine - analogs & derivatives / Procaine - economics / Prospective Studies / Regional anesthesia / Studies