A Novel Anesthetic Technique for PEVAR.
BACKGROUND
Percutaneous endovascular aneurysm repair (PEVAR) continues to evolve. Device profiles continue to decline, further reducing the physiological insult of the procedure. Anesthesia, however, has not evolved with a large proportion of patients continuing to receive general anesthesia for their increasingly less invasive procedures. We report on a novel anesthetic technique providing outstanding anesthesia in patients undergoing PEVAR in an outpatient setting. The total anesthesia used was remarkably cost effective.


METHODS
Six patients underwent PEVAR in an outpatient setting. The patients received moderate intravenous (IV) access sedation using versed and fentanyl in combination with bilateral ilioinguinal nerve blocks. Patients received 25 mL bilaterally of 0.5% bupivicaine with epinephrine. All patients were American Society of Anesthesiologists class III. None received central venous access, arterial, or urinary catheters. Standard noninvasive monitoring was used. A board-certified anesthesiologist was present at all times during the procedures.


RESULTS
All patients underwent successful repair. Average cost per case for anesthetic supplies averaged around $7.00. The fentanyl dose ranged from 100 to 200 μg with an average dose of 130 μg. Versed dose ranged from 2 to 3 mg with an average dose of 2.4 mg. No patient required conversion to general anesthesia. Postoperative pain relief was excellent. Two patients required pain medication before discharge. Two patients required oral narcotic analgesic the night of discharge. No patients required narcotics after that time.


CONCLUSIONS
Bilateral ilioinguinal nerve block, when combined with moderate IV sedation allows outstanding anesthesia for patients undergoing PEVAR. This novel combination has not been reported previously. The technique provides safe, effective, care for of a subset of patients not requiring general anesthesia. It offers a greatly reduced cost when compared with general anesthesia. Additional benefits include prolonged pain relief perioperatively as well as potentially decreasing the physiologic and cognitive effects seen with general anesthesia.
Coastal Vascular and Interventional Center, Pensacola, FL. Electronic address: stuart.a.harlin@uth.tmc.edu.
Stuart A
SA
Harlin
Coastal Vascular and Interventional Center, Pensacola, FL.
Ruth A
RA
Grissom
Coastal Vascular and Interventional Center, Pensacola, FL.
Christopher
C
LeCroy
Coastal Vascular and Interventional Center, Pensacola, FL.
Susan M
SM
Pouliot
Coastal Vascular and Interventional Center, Pensacola, FL.
Scott A
SA
Harlin
D000368:Aged; D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000783:Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000191:economics; D016292:Procedural Sedation / Q000009:adverse effects / Q000191:economics; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D057510:Endovascular Procedures / Q000009:adverse effects / Q000191:economics; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D008297:Male; D008874:Midazolam / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D008875:Middle Aged; D009407:Nerve Block / Q000009:adverse effects / Q000191:economics; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D008874:Midazolam; D005283:Fentanyl