Advances in regional anesthesia for outpatients

Abstract

This review will bring to the reader's attention recent developments in the literature regarding regional anesthesia in the outpatient setting, and allow the reader to evaluate whether these developments are appropriate for inclusion in clinical practice. The most stimulating developments in the area of regional anesthesia for outpatients revolve around the use of continuous analgesic therapy for outpatients after discharge. This is reflected in recent publications describing the use of continuous catheters for peripheral nerve blockade using portable pumps to provide 48-72 h of postoperative analgesia. These devices have raised the hope of opioid-free pain relief for virtually the entire duration of postsurgical pain in the outpatient setting. There are also increasing numbers of suggestions on ways to improve the quality of spinal anesthesia in the outpatient setting, particularly by using lower doses of lidocaine to reduce the problem of transient neurologic symptoms after spinal blockade. Several authors have investigated the cost implications of regional techniques in the outpatient setting, and have concluded that they are very competitive with the general anesthetic techniques that are frequently employed. Recent publications suggest additional ways to add regional anesthesia techniques to outpatient surgical practice, particularly with the promise of extensive postoperative pain relief for the ambulatory surgery patient.