title: Continuous versus single shot brachial plexus block and their relationship to discharge barriers and length of stay.
abstract: BACKGROUND
  Brachial plexus block has been associated with improved pain control and decreased length of stay in patients undergoing upper extremity arthroplasty. Continuous delivery is associated with a shorter length of stay; however, comparisons to single-shot delivery in this setting are scarce. As the paradigm shifts to outpatient arthroplasty in the era of bundled payments, there exists a strong impetus to identify the most effective mode of analgesia associated with the least risk to patients.
  
  
  METHODS
  This is a retrospective review of 697 patients undergoing upper extremity arthroplasty comparing the rate of complications and incidence of potential barriers to discharge and length of stay of patients receiving continuous vs. single-shot perineural brachial plexus block.
  
  
  RESULTS
  No difference was observed in the complication rate between indwelling (n = 63 [12%]) and single-shot groups (n = 30 [17%]; P = .137). The majority of complications were pulmonary, 72% attributable to oxygen desaturation. The indwelling catheter group had 1.61 times higher odds (95% confidence interval, 1.07-2.42; P = .023) of exhibiting any potential barrier to discharge and exhibited a longer length of stay (P = .002).
  
  
  CONCLUSIONS
  There was no demonstrated disparity in the rate of complications associated with single-shot vs. continuous brachial plexus block. However, the continuous indwelling catheter was associated with an increased incidence of potential barriers to discharge and an increased length of stay compared with patients receiving single-shot regional anesthesia.
authors.affiliation: Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA. Electronic address: matthew.thompson@vcuhealth.org.
authors.forename: Matthew
authors.initials: M
authors.lastname: Thompson
authors.affiliation: School of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Simonds
authors.affiliation: School of Medicine, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
authors.forename: Bryce
authors.initials: B
authors.lastname: Clinger
authors.affiliation: Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
authors.forename: Kristen
authors.initials: K
authors.lastname: Kobulnicky
authors.affiliation: Department of Biostatistics, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Sima
authors.affiliation: Department of Anesthesia, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Lahaye
authors.affiliation: Department of Orthopaedic Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA.
authors.forename: N Douglas
authors.initials: ND
authors.lastname: Boardman
mesh_terms: D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D000072228:Arthroplasty, Replacement, Shoulder / Q000009:adverse effects*; D065527:Brachial Plexus Block / Q000009:adverse effects / Q000379:methods*; D002408:Catheters, Indwelling / Q000009:adverse effects; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D010351:Patient Discharge; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local
keywords: Total shoulder arthroplasty; brachial plexus block; interscalene block; length of stay; postoperative pain; regional anesthesia; supraclavicular block