Can the choice of the local anesthetic have an impact on ambulatory surgery perioperative costs? Chloroprocaine for popliteal block in outpatient foot surgery.
OBJECTIVE
Short-acting regional anesthetics have already been successfully used for peripheral nerve blocks in an ambulatory surgery setting. However, the impact on direct and indirect perioperative costs comparing 2 different short-acting local anesthetics has not been performed yet.


METHODS
Observational, prospective, case-control, cost-minimization study.


METHODS
Operating room, regional hospital


METHODS
One hundred adult American Society of Anesthesiologists status I-III patients scheduled for popliteal block after minor ambulatory foot surgery.


METHODS
Application of 30 mL chloroprocaine 3% or of 30 mL mepivacaine 1.5% for anesthesia.


METHODS
Cost-minimization evaluation. Direct and indirect perioperative costs were calculated. Block success, onset time and block duration, patient satisfaction, and unplanned outpatient visits or readmissions after discharge were also assessed.


RESULTS
Onset time (sensory: 4.3 ± 2.4 vs 11.5 ± 3.2 minutes; motor: 7.1 ± 3.7 vs 18.4 ± 4.5 minutes) and block duration (sensory: 105 ± 26 vs 317 ± 46 minutes; motor: 91 ± 25 vs 216 ± 31 minutes) were significantly shorter (P < .001) when chloroprocaine 3% was used. This translated to P < .001, basically due to a faster discharge home 55 ± 1 vs 175 ± 2 minutes; P < .001) in favor of chloroprocaine 3%, without negatively affecting either block efficacy or patients satisfaction. There were no unplanned outpatient visits or readmissions and no complications in the follow-up at 6 weeks.


CONCLUSIONS
We conclude that the more expensive chloroprocaine 3% for ambulatory foot surgery can reduce total perioperative costs and reduce length of stay in outpatient patients. Moreover, the saved time and personal resources could be used for additional cases, further increasing the revenues of an ambulatory surgical center.
Anesthesiology Service, Bellinzona Regional Hospital, Switzerland. Electronic address: andrea.saporito@eoc.ch.
Andrea
A
Saporito
Anesthesiology Service, Bellinzona Regional Hospital, Switzerland. Electronic address: luciano.anselmi@eoc.ch.
Luciano
L
Anselmi
Division of Anesthesiology, Balgrist University Hospital Zurich, Switzerland. Electronic address: alain.borgeat@balgrist.ch.
Alain
A
Borgeat
Division of Anesthesiology, Balgrist University Hospital Zurich, Switzerland. Electronic address: jose.aguirre@balgrist.ch.
José A
JA
Aguirre
D000556:Ambulatory Surgical Procedures / Q000191:economics* / Q000379:methods; D000772:Anesthesia, Local / Q000191:economics; D000779:Anesthetics, Local / Q000191:economics; D016022:Case-Control Studies; D005260:Female; D005528:Foot / Q000601:surgery*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008619:Mepivacaine / Q000191:economics; D008875:Middle Aged; D009407:Nerve Block / Q000191:economics* / Q000379:methods; D019637:Orthopedic Procedures / Q000191:economics / Q000379:methods; D010045:Outpatients; D019990:Perioperative Care / Q000191:economics*; D011343:Procaine / Q000031:analogs & derivatives* / Q000191:economics; D011446:Prospective Studies
D000779:Anesthetics, Local; D011343:Procaine; C004616:chloroprocaine; D008619:Mepivacaine
Ambulatory anesthesia; Regional anesthesia