Impact of Regional Block Failure in Ambulatory Hand Surgery on Patient Management: A Cohort Study
by Lucile Picard 1,Pierre Belnou 2OrcID,Claire Debes 1,Nathanael Lapidus 2OrcID,Eileen Sung Tsai 3,Julien Gaillard 4,5,Alain Sautet 4,Francis Bonnet 1,6,Thomas Lescot 1,6 andFranck Verdonk 1,3,6,*OrcID
1
Department of Anesthesiology and Intensive Care, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France
2
Unité de Santé Publique, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France
3
Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
4
Orthopedic Surgery Department, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 75012 Paris, France
5
Orthopedic Surgery Department, American Hospital of Paris, 92200 Neuilly-sur-Seine, France
6
School of Medicine, Sorbonne University, 75012 Paris, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(8), 2453; https://doi.org/10.3390/jcm9082453
Abstract
Regional anesthesia (RA) is an anesthetic technique essential for the performance of ambulatory surgery. Failure rates range from 6% to 20%, and the consequences of these failures have been poorly investigated. We determined the incidence and the impact of regional block failure on patient management in the ambulatory setting. This retrospective cohort study includes all adult patients who were admitted to a French University Hospital (Hôpital Saint-Antoine, AP-HP) between 1 January 2016 and 31 December 2017 for unplanned ambulatory distal upper limb surgery. Univariate and stepwise multivariate analyses were performed to determine factors associated with block failure. Among the 562 patients included, 48 (8.5%) had a block failure. RA failure was associated with a longer surgery duration (p = 0.02), more frequent intraoperative analgesics administration (p < 0.01), increased incidence of unplanned hospitalizations (p < 0.001), and a 39% prolongation of Post-Anesthesia Care Unit (PACU) length of stay (p < 0.0001). In the multivariate analysis, the risk factors associated with block failure were female sex (p = 0.04), an American Society of Anesthesiologists (ASA) score > 2 (p = 0.03), history of substance abuse (p = 0.01), and performance of the surgery outside of the specific ambulatory surgical unit (p = 0.01). Here, we have documented a significant incidence of block failure in ambulatory hand surgery, with impairment in the organization of care. Identifying patients at risk of failure could help improve their management, especially by focusing on providing care in a dedicated ambulatory circuit.
Keywords: regional anesthesia; ambulatory surgery; block failure; patient management; risk factors