Ambulatory surgery with long acting regional anesthesia.

Ambulatory surgery has grown dramatically in the past 3 decades; however, advances in postoperative pain treatment have not kept pace with the proliferation of outpatient procedures. Two techniques that may offer a solution to part of this problem are long acting peripheral nerve blocks (PNB) and outpatient continuous peripheral nerve blocks (CPNB), but the safety of sending patients home with blocked extremities has also remained controversial. Unfortunately, only a few large, prospective studies have examined this issue directly. Those that have addressed this particular question support the concept that regional anesthesia and discharge with an insensate limb may be done safely. Our group prospectively studied 2,382 long-acting PNB with ropivacaine in both the upper and lower extremity noting a low incidence of block failure, rare use of opioids in the recovery unit and high patient satisfaction. This study also demonstrated a low incidence of accidental injury to the blocked extremity and a rare block complication rate after discharge (0.2%). Only 1 patient in this data set fell while exiting a car. Patients in our study appeared to uniformly protect themselves from further injury despite having a blocked extremity. In conclusion, PNB and perineural catheter techniques are an exciting aspect of ambulatory anesthesia and acute pain management that has undergone rapid development in recent years. Successful application of these techniques will require a substantial educational investment by anesthesiologists and anesthesiologists in training. The rewards in reduced postoperative pain, improved patient satisfaction, and anesthesiologist professional development make this endeavor worthy of our attention.