title: For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia.
abstract: BACKGROUND
  Both general and nerve block anesthesia are effective for shoulder surgery. For outpatient surgery, it is important to determine which technique provides more efficient recovery. The authors' goal was to compare nerve block with general anesthesia with respect to recovery profile and patient satisfaction after rotator cuff surgery.
  
  
  METHODS
  In this clinical trial, 50 consenting outpatients (aged 18-70 yr) were randomly assigned to receive either fast-track general anesthesia followed by bupivacaine (0.25%) wound infiltration or interscalene brachial plexus block (0.75% ropivacaine), each under standardized protocols. Blinded recovery room nurses assessed the need for pain treatment and rated patient eligibility for bypass of the phase 1 postanesthesia care unit and for discharge home. Patients were followed up for 2 weeks postoperatively. The primary outcome measures were postanesthesia care unit bypass and same-day discharge. Other same-day recovery outcomes included severity of and treatment for pain and time to ambulation. Postoperative outcomes at home included satisfaction with the anesthesia technique and absence of complications (at 2 weeks).
  
  
  RESULTS
  Patients who received nerve block (vs. general anesthesia) bypassed the postanesthesia care unit more frequently (76 vs. 16%; P < 0.001), reported less pain, ambulated earlier, were ready for home discharge sooner (123 vs. 286 min; P < 0.001), had no unplanned hospital admissions (vs. 4 of 25 patients who underwent general anesthesia; P = 0.05), and were more satisfied with their care. No complications were reported in either treatment group.
  
  
  CONCLUSIONS
  Nerve block anesthesia for outpatient rotator cuff surgery provides several same-day recovery advantages over general anesthesia.
authors.affiliation: Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons, Columbia University, New York, New York 10025, USA. ah149@columbia.edu
authors.forename: Admir
authors.initials: A
authors.lastname: Hadzic
authors.forename: Brian A
authors.initials: BA
authors.lastname: Williams
authors.forename: Pelin Emine
authors.initials: PE
authors.lastname: Karaca
authors.forename: Paul
authors.initials: P
authors.lastname: Hobeika
authors.forename: George
authors.initials: G
authors.lastname: Unis
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dermksian
authors.forename: Marina
authors.initials: M
authors.lastname: Yufa
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Thys
authors.forename: Alan C
authors.initials: AC
authors.lastname: Santos
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000556:Ambulatory Surgical Procedures; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D001917:Brachial Plexus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009407:Nerve Block; D019637:Orthopedic Procedures; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology; D011184:Postoperative Period; D011446:Prospective Studies; D017006:Rotator Cuff / Q000601:surgery*; D016896:Treatment Outcome