Abstract: A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials.
Liu SS, Strodtbeck WM, Richman JM, Wu CL
Department of Anesthesiology, Virginia Mason Medical Center, Seattle, WA 98111, USA.
Anesth Analg. 2005 Dec;101(6):1634-42.
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.
Anaesthesia General Regional