What are the advantages and disadvantages of selecting a nerve block technique for the ambulatory patient?
There are numerous advantages to selecting a nerve block technique when the type of surgery permits. The ability to continue profound analgesia into the postoperative period provides for patient comfort, which may allow early return home from the facility. However, rapid return to presurgical levels of mental alertness and acuity can be achieved only if judicious amounts of sedative drugs are administered during both performance of the block and surgery. Patients may have a decreased incidence of nausea in the early post-operative period if smaller amounts of intravenous opioids are required or can be avoided entirely. This may also allow earlier alimentation and a speedier return to normal functioning.
There are a few disadvantages to performing nerve blocks in the ambulatory surgical patient. Preparation and performance of a block anesthetic may require more time than the induction of a general anesthetic. In some instances, the actual performance of a regional block and establishment of surgical anesthesia may take longer than the proposed operation. Brachial plexus and other nerve blocks have a known failure rate, and incomplete or inadequate anesthesia will further delay the onset of sur-gery. Some patients will not tolerate any sensation whatso-ever and may require inordinately large amounts of sedative drugs throughout the procedure. This might easily negate some of the advantages of selecting a regional approach.
Unfortunately, patients who have not been seen by an anesthesiologist before the actual day of surgery and arrive with the expectation of receiving a general anesthetic may be unprepared to accept another technique. The surgeon’s pref-erence will also influence the receptiveness of a patient to a regional technique. A surgeon who prefers the use of major conduction anesthesia or nerve blocks will often inform patients of the benefits and availability of these techniques during a preoperative discussion of the proposed surgery.