Search

Background: Local anesthesia has shown to be safe and cost-effective for elective hand surgery procedures performed outside of the operating room. The economic benefits of local anesthesia compared to regional anesthesia for hand surgeries performed in the operating room involving repair of tendons, nerves, arteries, or bones are unclear. This study aimed to compare costs pertinent to hand surgeries performed in the main operating room under local anesthesia (LA) or brachial plexus (BP) block. Methods: We performed a cross-sectional study on the first 70 randomized patients from a prospective controlled trial of anesthesia modalities for hand surgery. The primary objective was to determine the mean anesthesia-related cost, and the secondary objectives were to analyze block performance time, block onset time, duration of anesthesia, duration of surgery, and time in the recovery room. Results: The mean anesthesia-related cost of performing hand surgery under LA as a wrist and/or digital block was $236 ± 30, compared to $435 ± 43 for BP, a difference of $199 per case. The mean block performance time was shorter for LA (1.3 minutes) versus BP (7.0 minutes). The mean anesthesia-related time was longer in BP (30.7 ± 16 minutes) compared to LA (17.7 ± 6.7 minutes), and consequently the total anesthesia time was longer in BP. Conclusions: We demonstrated that local anesthesia compared to brachial plexus block achieved substantial cost savings in complex hand surgeries by decreasing major expenses. In an era of cost-consciousness, the use of LA represents an important modality for health systems to optimize patient flow and increase cost-effectiveness.

Background Accessible interdisciplinary, patient-centered and integrated primary care programs for chronic pain are needed for averting chronicity and improving patient outcomes. We sought 1) to develop an interdisciplinary low back pain (LBP) primary care program, and 2) to evaluate the program’s implementation and impact on patients’ physical and mental health over 6 months. A quasi-experimental pre-test/post-test design was used, and participants completed baseline, 3 and 6 months post-intervention evaluations. Referral and program process indicators were measured. Methods Clinically meaningful change in patient reported outcome measures of pain interference and intensity, physical function, depression and anxiety were defined a priori and evaluated. A multilevel regression analysis was performed to evaluate the impact of the program on change in individuals’ pain interference over 6 months. Results Forty six percent of participants were seen within 60 days of referral to the LBP program, and 464 individuals completed the program. The majority (≥ 60%) experienced a clinically meaningful improvement for pain intensity and interference at six months. A greater proportion of those with moderate (71%) or high risk (81%) of chronicity showed an improvement in pain interference than those with low risk (51%). A similar pattern emerged for depression and self-efficacy, but not for anxiety. Significant predictors of improvements in pain interference included higher prognostic risk of chronicity, younger age, sex, and lower baseline disability. Conclusion Results supported an improvement in participants’ confidence to manage their LBP. Future research will compare alternative modes of delivery (e.g. telehealth) and stratification approaches to further tailor resources to individuals’ needs.

We measured the tidal volumes (VT) delivered by two anesthesia ventilators (the Narkomed 2B and the Ohmeda 7800) to a model lung at frequencies of 60 breaths/min and 99-100 breaths/min under two conditions of compliance and resistance designed to mimic mild and severe adult respiratory distress syndrome (ARDS) (mild ARDS = S1 and severe ARDS = S2). The VT produced were measured with a pneumotachometer at the ventilator outflow and distal to the anesthesia circuit. With the Narkomed 2B, the VT measured at the entrance to the model lung decreased from 216 mL to 129 mL in S1, and from 152 mL to 88 mL in S2 as the ventilatory frequency increased from 60 to 99 breaths/min. With the Ohmeda 7800, the VT decreased from 213 mL to 118 mL in S1, and from 134 mL to 73 mL in S2 when the frequency was changed from 60 to 100 breaths/min. Since the delivered VT are similar to those previously reported to maintain adequate ventilation at these rates using standard high-frequency ventilation (HFV), it may be possible to use these newer anesthesia ventilators for this purpose.