• L Ehlers, J M Jensen, and T F Bendtsen.
• Danish Center for Health Care Improvements, Faculty of Social Sciences and Faculty of Health Sciences, Aalborg University, Denmark.
• Br J Anaesth. 2012 Nov 1;109(5):804-8.

BackgroundThis study assessed the cost-effectiveness of ultrasound (US) vs nerve stimulation (NS) guidance for continuous sciatic nerve block in Danish elective patients undergoing major foot and ankle surgery.Methods> A cost-effectiveness analysis was conducted alongside a randomized controlled trial. A total of 100 consecutive patients were randomly assigned to either traditional electrical NS or US technique for catheter insertion guidance. Information on effects and costs were collected prospectively. An incremental cost-effectiveness ratio (ICER) was calculated as the extra cost per extra successful nerve block. The robustness of the ICER was investigated using 4000 non-parametric bias-corrected bootstrap replicates to calculate the likelihood that US leads to better effect and lower costs compared with NS guidance.ResultsThe mean ICER was negative, indicating that US was a dominating technology providing both higher quality and lower costs. The likelihood of US being more effective and cheaper than NS was estimated to 84.7%.ConclusionsIn this trial, US was cost-effective. Assuming that the results are fairly generalizable, US should be the preferred catheter insertion technique in larger anaesthesia departments.

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