Abstract
Purpose
Regional anesthesia can be the technique of choice for selected ambulatory surgery procedures, but in spite of its benefits, it has an inherent failure rate even in experienced hands. We examine the efficacy and factors associated with failure of ambulatory regional anesthesia techniques.
Methods
This study included 9,342 blocks performed on 7,160 patients at the Duke University Ambulatory Surgery Center. Blocks were classified as interscalene, supraclavicular, axillary, lumbar plexus, femoral, sciatic, ankle, paravertebral, spinal, and other (frequency less than 100). A block was considered surgical if a single attempt at placing the block resulted in a complete sensory, motor, and sympathetic nerve block. Multiple logistic regression analyses were used to assess the risk-adjusted association between patient characteristics and block failure.
Results
Paravertebral blocks and those considered in the “other” category had significantly higher failure rates (P < 0.001 ), while spinal and lumbar plexus blocks had lower than average rates of failure (P < 0.001 andP = 0.03, respectively). In multiple logistic regression analyses excluding paravertebral blocks, body mass index (BMI) scores greater than 25 (P values: BMI 25–29: < 0.001; BMI 30–34:P < 0.001; BMI 35:P < 0.001) and ASA physical status IV (P < 0.001 ) were significantly associated with higher block failure rates.
Conclusion
High BMI and ASA IV are independent risk factors for block failure in ambulatory surgery patients.
Résumé
Objectif
L’anesthésie régionale peut être la technique de choix pour certaines interventions chirurgicales ambulatoires, mais en dépit de ses avantages, elle présente un taux d’échec inhérent même entre des mains expertes. Nous vérifions l’efficacité des techniques d’anesthésie régionale ambulatoire et les facteurs associés à son échec.
Méthode
Notre étude comprend 9 342 blocs réalisés sur 7 160 patients au Duke University Ambulatory Surgery Center. Les blocs ont été classifiés comme interscalène, supraclaviculaire, axillaire, du plexus lombaire, fémoral, sciatique, de la cheville, paravertébral, rachidien et autre (d’une fréquence de moins de 100). Un bloc était considéré chirurgical si un seul essai provoquait un blocage nerveux sensitif, moteur et sympathique. Des analyses de régression logistique multifactorielle ont servi à évaluer l’association ajustée au risque entre les caractéristiques du patient et l’échec du bloc.
Résultats
Les blocs paravertébraux et ceux de la catégorie «autre» avaient un taux d’échec significativement plus élevé (P < 0,001), tandis que les blocs rachidiens et ceux du plexus lombaire avaient un taux d’échec sous la moyenne (P < 0,001 etP = 0,03, respectivement). Dans les analyses de régression logistique excluant les blocs paravertébraux, les indices de masse corporelle (IMC) de plus de 25 (IMC de 25–29:P < 0,001; IMC de 30–34:P < 0,001; IMC de 35:P < 0,001) et un état physique ASA N (P < 0,001) étaient significativement associés à des taux d’échec de bloc plus élevés.
Conclusion
Un IMC élevé et un état physique ASA IV sont des facteurs de risque indépendants d’échec du bloc en chirurgie ambulatoire.
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Financial support provided by the Division of Ambulatory Anesthesia, Duke University Medical Center.
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Cotter, J.T., Nielsen, K.C., Guller, U. et al. 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 51, 810–816 (2004). https://doi.org/10.1007/BF03018454
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DOI: https://doi.org/10.1007/BF03018454