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AMBULATORY ANESTHESIA

A Comparison of Regional Versus General Anesthesia for Ambulatory Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Spencer S. Liu, MD^*, Wyndam M. Strodtbeck, MD^*, Jeffrey M. Richman, MD, and Christopher L. Wu, MD

Departments of Anesthesiology, *Virginia Mason Medical Center and the University of Washington, Seattle, Washington; Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland

Address correspondence to Spencer S. Liu, MD, Department of Anesthesiology, Virginia Mason Medical Center, 1100 Ninth Avenue, P.O. Box 900, Mail Stop B2-AN, Seattle, WA 98111. Address electronic mail to anessl{at}vmmc.org.

Both regional anesthesia and general anesthesia have been proposed to provide optimal ambulatory anesthesia. We searched MEDLINE and other databases for randomized controlled trials comparing regional anesthesia and general anesthesia in ambulatory surgery patients for meta-analysis. Only major conduction blocks were considered to be regional anesthesia. Regional anesthesia was further separated into central neuraxial block and peripheral nerve block. Fifteen (1003 patients) and 7 (359 patients) trials for central neuraxial block and peripheral nerve block were included in the meta-analysis. Both central neuraxial block and peripheral nerve block were associated with increased induction time, reduced pain scores, and decreased need for postanesthesia care unit analgesics. However, central neuraxial block was not associated with decreased postanesthesia care unit bypass or time or reduced nausea despite reduced analgesics, and it was associated with a 35-min increase in total ambulatory surgery unit time. In contrast, peripheral nerve block was associated with decreased postanesthesia care unit need and decreased nausea but, again, not with decreased ambulatory surgery unit time. This meta-analysis indicates potential advantages for regional anesthesia, such as decreased postanesthesia care unit use, nausea, and postoperative pain. Although these factors have been proposed to reduce ambulatory surgery unit stay, neither central neuraxial block nor peripheral nerve block were associated with reduced ambulatory surgery unit time. Other factors, such as unsuitable discharge criteria and limitations of meta-analysis, may explain this discrepancy.

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