Research Priorities Regarding Multimodal Peripheral Nerve Blocks for Postoperative Analgesia and Anesthesia Based on Hospital Quality Data Extracted from Over 1,300 Cases (2011–2014): Table 1

Abstract

The use of additives with local anesthetics for peripheral nerve blocks has received considerable attention [1] due to the patient-centered goals of prolonging analgesic duration and possibly reducing local anesthetic-related toxicity. Applying such additives to single-injection nerve blocks also has the potential to reduce overhead [2] and disposables [3] costs, when compared with the costs related to continuous perineural infusions. Furthermore, recent research has elucidated in vivo animal sciatic nerve safety of the preservative-free combination of clonidine, buprenorphine, and dexamethasone (CBD) with the local anesthetic bupivacaine (BPV) [4]. Ropivacaine–CBD was previously demonstrated to be no more neurotoxic than plain ropivacaine to cultured primary sensory neurons harvested from rat dorsal root ganglia in vitro [5]. In our institution (Veterans Affairs Pittsburgh Healthcare System [VAPHS]), the lead author was in charged with creating a regional anesthesia (RA) and analgesia program for patients eligible for peripheral nerve blocks. For this new program, hospital administration was unable to budget resources for a perineural catheter-based acute pain service. Instead, the Medical Executive Board approved the lead author's recommendation to routinely use BPV–CBD off-label. These single-injection nerve block procedures are typically placed before surgery to provide postoperative analgesia and intraoperative anesthesia when feasible, and thus avoiding general endotracheal anesthesia (GETA). The Medical Executive Board tasked the lead author with per-patient quality assurance/quality improvement (QA/QI) data collection to evaluate comparative effectiveness (against historical controls) and outcomes (block duration and rebound pain [6,7], perineural complications, etc.). In accordance with Veterans Health Administration Handbook 1058.05, this manuscript was processed for authentication of nonresearch status of the activities prior to submission to this journal. Our institutional review board declared these clinical operations as “not research” at the time of program initiation (mid-2011) and annually since then during required reviews. The objective is to describe the patient outcomes …