Regional Anesthesia Can Lead to Better Patient Outcomes

Better management of anesthesia — techniques, patient selection and efficiency — has potential to add value to orthopedic practices, according to Michael R. Redler, MD, and Barry Stein, MD, both of the Surgery Center of Fairfield County, in their talk titled "The Partnership Between Anesthesia and Orthopedics for the Best Regional Anesthetic Care in Orthopedic Practices," at the 12th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + Future of Spine on June 12, 2014 in Chicago.

The current challenges for surgeons in the orthopedic operating room including maximizing efficiency and increasing the range of possible cases, while performing shorter surgeries and controlling implant and disposable implant costs. According to Dr. Redler, anesthesia management in conjunction with patient selection can set orthopedic ASC cases up for success.

According to Dr. Stein, the value-focused paradigm shift in healthcare delivery means that appropriate patient selection is the most important step surgeons can take to ensure the delivery of valuable care and the potential for success in anesthesia techniques that minimize nausea and pain: "Appropriate patient selection — that's the most critical point. When you screen patients appropriately, it avoids complications, improves coordination of patient care and improves patient satisfaction," he said.

From the anesthesia management standpoint, Dr. Stein recommends using updated best practices for anesthesia, using internal benchmarking and monitoring patient outcomes: nausea and satisfaction. Regional anesthesia, he said, can keep those outcomes where they need to be.

"Pain is the number one cause of dissatisfaction on HCAHPS ambulatory scores," said Dr. Stein. "Multimodal pain management and regional anesthesia are more suitable than opioids. Ninety-five percent of patients have opiate-based side-effects," he added. "Regional anesthesia improves pain scores, lowers nausea and vomiting and even works for obese patients."

Citing the need for a good relationship between anesthesia and orthopedics to have a successful, value-based environment for orthopedics cases, the pair recommended ASCs identify anesthesiology partners who are willing to learn about regional anesthesia, as well as implementing patient education about regional anesthesia.

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