Non-inferiority trial of a pedal controlled injection device: a step toward enhancing patient safety and operator independence during neural blockade

Journal of Pain Research ◽

10.2147/jpr.s166335 ◽

2019 ◽

Vol Volume 12 ◽

pp. 571-577

Author(s):

Syed Reefat Aziz ◽

Daryl Smith ◽

Rose Mbaye ◽

Jacob Gusman ◽

Estefania Garza ◽

...

Keyword(s):

Patient Safety ◽

Injection Device ◽

Neural Blockade

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Obstetric Postanesthesia Care Unit Stays

Anesthesiology ◽

10.1097/00000542-199812000-00036 ◽

1998 ◽

Vol 89 (6) ◽

pp. 1559-1565 ◽

Cited By ~ 9

Author(s):

Sheila E. Cohen ◽

Catherine L. Hamilton ◽

Edward T. Riley ◽

Dean S. Walker ◽

Alex Macario ◽

...

Keyword(s):

Patient Safety ◽

Side Effects ◽

Vital Signs ◽

Tubal Ligation ◽

Postanesthesia Care Unit ◽

Prospective Data ◽

Neural Blockade ◽

Cumulative Duration ◽

Residual Block ◽

Discharge Criteria

Background Obstetric patients may have long postanesthesia care unit (OB-PACU) stays after surgery because of residual regional block or other conditions. This study evaluated whether modified discharge criteria might allow for earlier discharge without compromising patient safety. Methods Data were prospectively collected for 6 months for all patients (N=358) who underwent cesarean section or tubal ligation and recovered in the OB-PACU. Regional anesthesia was used in 94% of patients. The duration of anesthesia and PACU stays, the presence and treatment of events in the PACU, and the regression of neural blockade were recorded. Discharge from the OB-PACU required a 60-min minimum stay, stable vital signs, adequate analgesia, and ability to flex the knees. After completion of prospective data collection, events that kept patients in the PACU after 60 min were reevaluated as to whether patients needed to stay in the PACU for medical reasons. "Needed to stay" events included bleeding, cardiorespiratory problems, sedation, dizziness, and pain. "Safe to leave" conditions included pruritus, nausea, and residual neural blockade. The cumulative duration of OB-PACU stays not clearly justifiable for medical reasons was calculated. Results Residual block and spinal opioid side effects accounted for the majority of "unnecessary" stays. Annually, 429 h of PACU time could have been saved using the revised criteria. Complications did not develop subsequently in any patient deemed "safe to leave." Conclusions In many obstetric patients, the duration of PACU stays could safely be shortened by continuing observation in a lower-acuity setting. This may result in greater flexibility and more efficient use of nursing personnel.

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