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AMBULATORY ANESTHESIA

Total Shoulder Arthroplasty as an Outpatient Procedure Using Ambulatory Perineural Local Anesthetic Infusion: A Pilot Feasibility Study

Brian M. Ilfeld, MD, MS^*, Thomas W. Wright, MD, F. Kayser Enneking, MD^*, Jennie A. Mace, MD^*, Jonathan J. Shuster, PhD, Eugene H. Spadoni, PT, Terese L. Chmielewski, PhD, PT, and Krista Vandenborne, PhD, PT

Departments of *Anesthesiology, Orthopaedics and Rehabilitation, Statistics, and Physical Therapy, University of Florida, Gainesville, Florida

Address correspondence and reprint requests to Brian M. Ilfeld, MD, Department of Anesthesiology, P.O. Box 100254, 1600 SW Archer Rd., Gainesville, FL 32610-0254. Address e-mail to bilfeld{at}ufl.edu.

We investigated the feasibility of converting total shoulder arthroplasty (TSA) into an outpatient procedure using ambulatory interscalene perineural ropivacaine infusion. Of the patients of the first phase (n = 8) who were required to remain hospitalized for at least 1 postoperative night, 5 met discharge criteria in the recovery room. Of the subsequent patients of the second phase (n = 6), all met discharge criteria in the recovery room after surgery, and 5 were discharged directly home. For all patients, postoperative pain was well controlled, oral opioid requirements and sleep disturbances were minimal, range-of-motion consistently reached or exceeded the surgeon’s expectations, and patient satisfaction was high. These results suggest that TSA may be performed on an outpatient basis using perineural local anesthetic infusion. Additional research is required to define the appropriate subset of patients and assess the incidence of complications associated with this practice before its mainstream use.

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