PubMed · 13199751
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T L FISHER. 1954. Office surgery.. https://pubmed.ncbi.nlm.nih.gov/13199751/
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BACKGROUND: Single-shot nerve blocks provide excellent postoperative analgesia for a limited period and are increasingly used in day-case units. They allow early patient discharge following painful operative procedures that would otherwise require overnight hospitalization. We investigated the adequacy of analgesia at home after the block had worn off. METHODS: A prospective audit by telephone 1 week after surgery of 50 consecutive patients who had had a single-shot interscalene block for day-case shoulder arthroscopic surgery. RESULTS: The mean length of adequate sensory block was 22.5 h (9-48 h) after which 20% of patients had a maximum visual analogue scale (VAS) score of 5/5. Most patients did not take analgesics as prescribed and two patients (5.4%) required additional analgesia from their family doctor or accident and emergency department. CONCLUSIONS: We conclude that analgesia at home is often inadequate after painful day-case surgical procedures if single-shot local anaesthetic blockade is used.
The high cost of treatment of varicose veins has an important role in public health care. The search for a less expensive and office-based procedure led to introduction of tumescent local anesthesia for use in ambulatory phlebectomy. Although the overall infection rate is low, severe infection has been reported after liposuction with tumescent anesthesia. We report necrotizing fasciitis, an infection with a mortality rate of 30% to 50%, after ambulatory phlebectomy and stripping of the long saphenous vein with use of tumescent anesthesia.
A surgical pain improvement team used an improvement model to standardize pain management at two hospital-based ambulatory surgery facilities.