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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia01:16

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Estimating 90th Percentile Times To Complete Multiple Pre-Operative Regional Anesthesia Procedures To Mitigate

Franklin Dexter1, Richard H Epstein2, Rakesh V Sondekoppam3

  • 1Department of Anesthesia, University of Iowa, 200 Hawkins Drive, Iowa City, IA, 52242, United States of America. Franklin-Dexter@UIowa.edu.

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|April 16, 2025
PubMed
Summary

Insufficient preoperative time for regional blocks causes operating room delays. Predicting procedure completion times using probability distributions helps mitigate these delays for first-case starts.

Keywords:
Anesthesia, ConductionEfficiency, OrganizationalModels, StatisticalNerve BlockOperating Rooms/organization and administrationPersonnel Staffing and Scheduling

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Area of Science:

  • Anesthesiology
  • Operating Room Management
  • Health Services Research

Background:

  • Delays in first-case operating room starts are frequently caused by insufficient time allocated for preoperative regional blocks.
  • Accurate prediction of regional block procedure times is crucial for effective operating room scheduling.

Purpose of the Study:

  • To test hypotheses for planning regional block start times to mitigate first-case operating room delays.
  • To evaluate the relationship between the number of procedures and procedure completion times.

Main Methods:

  • Retrospective cohort study of regional anesthetic procedures in two academic hospital surgical suites.
  • Analysis of procedure completion times using quantile regression, focusing on the 0.5 (median) and 0.9 quantiles.
  • Statistical analysis including Bonferroni adjustment for multiple comparisons.

Main Results:

  • Increased total minutes of regional procedures correlated with greater first-case start lateness and tardiness.
  • The number of procedures per day did not significantly affect the median (0.5 quantile) time per procedure.
  • Increases in procedures per day were associated with significant decreases in the 0.9 quantile time per procedure, supporting the hypothesis that total time is less than the sum of individual 0.9 quantiles.

Conclusions:

  • Quantile regression or log-normal distribution models can predict regional block start times to minimize first-case delays.
  • Estimated completion times for multiple procedures are shorter than the sum of individual 0.9 quantiles but longer than the sum of medians.
  • Optimized scheduling using these predictive methods allows for sufficient time for multiple procedures before the first case, reducing operating room delays.