title: Patient outcomes comparing CRNA-administered peripheral nerve blocks and general anesthetics: a retrospective chart review in a US Army same-day surgery center.
abstract: We compared outcomes between patients receiving general anesthesia (GA) vs regional block (RB) in a military same-day surgery unit (SDSU), where Certified Registered Nurse Anesthetists (CRNAs) delivered all RBs and GA. All patient charts from 2003 through 2006 were reviewed. Patients were included if they were 18 years or older, had an ASA physical status I or II, and underwent a shoulder or knee arthroscopy that used either RB or GA. Overall, 342 patients met inclusion criteria: 161 GA and 181 RB. With GA, mean anesthesia time was shorter (109.6 vs 135.5 minutes, P < .001), but recovery times were longer (56.7 vs 36.4 minutes, P < .001). SDSU times were nearly identical (GA vs RB, 71.5 vs 72.8 minutes), resulting in a total hospital time that was not significantly different (352.7 vs 347.5). The GA group received more morphine equivalents of narcotic in the operating room (22.9 vs 15.1 mg, P < .001) yet still had higher pain scores postoperatively than the RB group (1.1 vs 0.3, P < .001). The GA group received a significantly greater number of antiemetic doses intraoperatively (0.58 vs 0.04, P < .001) but still had a higher, although nonsignificant, rate of emesis (15.5% vs 10.0%). Patients receiving RB had less pain and received less analgesia without any increase in postoperative nausea and vomiting, hospital time, or anesthesia-related complications.
authors.affiliation: Walter Reed Army Medical Center, Washington, DC, USA. jyauger1@gmail.com
authors.forename: Young J
authors.initials: YJ
authors.lastname: Yauger
authors.forename: Jay A
authors.initials: JA
authors.lastname: Bryngelson
authors.forename: Kaon
authors.initials: K
authors.lastname: Donohue
authors.forename: Lori A
authors.initials: LA
authors.lastname: Lawhorn
authors.forename: Brian M
authors.initials: BM
authors.lastname: Pitcher
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Schoneboom
authors.forename: Dorraine D
authors.initials: DD
authors.lastname: Watts
mesh_terms: D000556:Ambulatory Surgical Procedures / Q000009:adverse effects; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000379:methods / Q000451:nursing; D015400:Clinical Nursing Research; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008396:Maryland / Q000453:epidemiology; D009407:Nerve Block / Q000379:methods / Q000451:nursing; D009719:Nurse Anesthetists / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D010525:Peripheral Nerves; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors