• Randall J Malchow, Rajnish K Gupta, Yaping Shi, Matthew S Shotwell, Lisa M Jaeger, and Clifford Bowens.
• Department of Anesthesiology and Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
• Pain Med. 2018 Feb 1; 19 (2): 368-384.

ObjectiveThe authors investigated a wide range of perioperative outcome measures in the context of a robust regional anesthesia practice.DesignComprehensive review of a prospectively collected six-year database.SettingFreestanding, academic ambulatory surgery center.SubjectsThere were 13,897 consecutive regional anesthetics in 10,338 patients.MethodsWe investigated patient satisfaction, postoperative nausea and vomiting (PONV), postoperative pain, catheter analgesia, and complications. Clinical risk factors were examined and presented as odds ratios for multiple outcome analyses including block success, patient satisfaction, PONV, and postoperative neurologic symptoms (PONS).ResultsDecreased block success was associated with nerve stimulation alone (P < 0.001), obesity (P = 0.001), higher American Society of Anesthesiologists classification (ASA; P = 0.01), lower extremity blocks (P = 0.04), and male sex (P < 0.001). Decreased patient satisfaction was associated with poor catheter analgesia (P < 0.001), complications (P < 0.001), higher ASA (P = 0.001), and younger age (P = 0.008). PONV was associated with postoperative pain (P < 0.005), female sex (P < 0.001), general anesthesia (P < 0.001), younger age (P = 0.001), lack of catheter (P = 0.03), and lack of dexamethasone/clonidine (D + C) adjuncts (P = 0.01). Serious complications and unexpected hospitalizations were rare (<0.2%). D + C adjuncts, lower extremity blocks, clonidine (but not dexamethasone alone), and female sex were associated with PONS (all P < 0.001).ConclusionsA regional anesthesia-based practice in ambulatory surgery is an effective means of providing excellent postoperative analgesia and is associated with a low rate of PONV and unexpected admissions. Dexamethasone, clonidine, and their combination when combined with 0.5% ropivacaine may have mixed effects on PONS risk that warrant dose/concentration alterations of these three drugs in the context of off-label perineural adjunct use.© 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

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