Readiness for Discharge After Foot and Ankle Surgery Using Peripheral Nerve Blocks: A Randomized Controlled Trial Comparing Spinal and General Anesthesia as Supplements to Nerve Blocks

Anesthesia and Analgesia
Jacques T YaDeauMatthew M Roberts

Abstract

Neuraxial anesthesia is often viewed as superior to general anesthesia but may delay discharge. Comparisons do not typically use multimodal analgesics and nerve blockade. Combining nerve blockade with general anesthesia may reduce pain, opioid consumption, and nausea. We hypothesized that general anesthesia (with nerve blocks) would lead to earlier readiness for discharge, compared to spinal anesthesia (with nerve blocks). All patients underwent ambulatory foot and ankle surgery, with a predicted case duration of 1-3 hours. All patients received popliteal and adductor canal nerve blocks using bupivacaine and dexamethasone. No intraoperative opioids were administered. All patients received ondansetron, dexamethasone, ketamine, and ketorolac. Patients, data collectors, and the data analyst were not informed of group assignment. Patients were randomized to spinal or general anesthesia with concealed allocation. Spinal anesthesia was performed with mepivacaine and accompanied with propofol sedation. After general anesthesia was induced with propofol, a laryngeal mask airway was inserted, followed by sevoflurane and propofol. Time until ready for discharge, the primary outcome, was compared between groups after adjusting for age and...Continue Reading

References

Feb 1, 1995·Journal of Clinical Anesthesia·J A Aldrete
Mar 11, 1999·Anesthesia and Analgesia·S I Marshall, F Chung
Jan 29, 2003·Anesthesiology·Alain BorgeatCarlo A Schenker
Apr 30, 2005·Journal of Palliative Medicine·D B GordonK Ford-Roberts
Aug 24, 2005·Anesthesia and Analgesia·Jacques T YaDeauVictor M Zayas
Nov 23, 2012·The Journal of Bone and Joint Surgery. American Volume·Benjamin E SteinJohn H Wilckens
Oct 22, 2013·Clinical Orthopaedics and Related Research·John M CoreyJesse M Ehrenfeld
May 15, 2015·Regional Anesthesia and Pain Medicine·Jacques T YaDeauDavid S Levine

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Citations

Dec 19, 2020·Foot & Ankle International·Bavornrit ChuckpaiwongTheerawoot Tharmviboonsri

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