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IMPLEMENTATION OF REGIONAL ANAESTHESIA SERVICE FOR AWAKE UPPER LIMB PLASTIC SURGERY – IMPACT ON LENGTH OF STAY, DRUG COSTS AND PATIENT SATISFACTION
ESRA Academy. Dunham M. Sep 8, 2016; 138345; 0181 Topic: Peripheral Nerve Blocks
Dr. Mark Dunham
Dr. Mark Dunham

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Abstract
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Background and Aims:

Regional anaesthesia (RA) allows awake surgery on the upper limb. Avoidance of general anaesthesia (GA) may lead to faster recovery times, reduced costs and improved patient satisfaction. We recently introduced a RA service for day case plastic surgery patients to allow awake surgery. We have performed a service evaluation to assess the impact of this on duration of stay, cost and patient satisfaction over the first six months.

Methods:

All patients undergoing awake upper limb surgery under RA (ultrasound guided supraclavicular brachial plexus block +/- distal nerve block) without sedation were included. Data was collected regarding length of stay and drug cost. A comparison group of patients undergoing similar surgery under GA was also included. All RA patients were contacted to assess satisfaction using a structured questionnaire.

This project was approved by the Hospital Clinical Audit Department which considers Ethical Implications.


Results:

Table 1 shows median duration in anaesthetic room, duration of surgery, recovery and interval between end of surgery and hospital discharge.

The mean drug cost for GA patients was £3.65 (excluding volatile cost – estimated to be £10/hour using sevoflurane). The mean drug cost for RA patients was £2.12.

There were no block failures.

28/39 (72%) RA patients were successfully followed up. Patient satisfaction was high - see Table 2.


Table 1



Table 2

Conclusions:

Implementation of a RA service for awake upper limb plastic surgery led to reduced length of stay and costs. 

Patient satisfaction was very high.

This technique may also lead to similar improvements in other upper limb surgery eg orthopaedics.

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