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Slow resolution of block and incidence of side effects deter many practitioners from choosing spinal anesthesia for outpatient surgical procedures. Some studies suggest that controlling bevel or side port orientation of a spinal needle during anesthetic injection can affect occurrence of side effects and time to block resolution. The objective of this study was to determine the effects of varying Pencan spinal needle (B-Braun, Bethlehem, Pa) side port orientations on duration of block and incidence of side effects in groups of patients receiving spinal anesthesia.
We randomized 87 subjects scheduled for spinal anesthesia to receive a spinal anesthesia injection using a cephalad, lateral, or caudad side port orientation. Onset, duration, block height, incidence of side effects, and analgesic requirements were among the variables measured.
No difference in onset, duration, or analgesic requirements was noted among groups. Differences were noted in time to discharge from the hospital (P = .027) and time to first voiding (P = .023) in the lateral compared with the cephalad and caudad orientation groups.
Patients in whom the lateral needle side port orientation was used for injection were discharged earlier and had fewer side effects. This could translate into significant savings, financially and in terms of staff requirements.
Key words: Bevel orientation, bupivacaine, fentanyl, Pencan spinal needle, spinal anesthesia.
Outpatient surgery relies on the rapid induction, recovery, and discharge of the patient as a means of controlling costs. In studies comparing spinal anesthesia with general anesthesia, no unequivocal, compelling data have clearly distinguished the safety and efficacy of general anesthesia vs spinal block.1-4 Therefore, cost may be an influential factor when choosing an anesthetic technique.
The cost of an anesthetic not only includes the cost of the individual medications administered, but also factors in the relative cost of the care required following the surgical procedure. This postsurgical care includes time required in the postanesthesia care unit (PACU) and same-day surgery units (SDSU), and this time can account for a significant portion of the overall cost.5 Patients must remain in the PACU and SDSU until anesthesia has resolved sufficiently to allow for discharge and side effects of anesthesia such as nausea, vomiting, and pain are controlled. Of these, resolution of the anesthetic is the most difficult aspect to control and...