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General Considerations for Regional Anesthesia Practice

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Essentials of Regional Anesthesia

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Abstract

Setting up a regional anesthesia service requires a reliable and consistent product as well as a sound business plan. Technological advances in nerve stimulation, ultrasound guidance, and perineural catheters have led to rapid growth in the number and types of peripheral nerve block procedures available to regional anesthesia practitioners. Starting a new regional anesthesia program potentially adds monetary value to a facility’s perioperative services by improving the quality of postoperative analgesia and recovery from surgery, thereby reducing perioperative costs and offering a competitive advantage over other surgical facilities. From the patient’s perspective, a regional anesthesia program provides nonmonetary value by preventing pain and reducing the risk of nausea and vomiting after surgery. The goal of this chapter is to provide initial guidance to the anesthesiologist interested in starting a new regional anesthesiology and acute pain program.

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Acknowledgment

The authors wish to thank Edward R. Mariano and Karley J. Mariano for their significant contribution to the prior edition.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Montefiore Medical Center, Bronx, NY, USA

    Svetla Kurteva MD

  2. Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Iyabo Olubunmi Muse MD

  3. Regional Anesthesia and Acute Pain Medicine, Department of Anesthesiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Karina Gritsenko MD

Authors
  1. Svetla Kurteva MD
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  2. Iyabo Olubunmi Muse MD
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  3. Karina Gritsenko MD
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Corresponding author

Correspondence to Karina Gritsenko MD .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA

    Alan David Kaye

  2. Department of Anesthesiology Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA

    Richard D. Urman

  3. Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Nalini Vadivelu

Review Questions

Review Questions

  1. 1.

    Regarding the ways regional anesthesia provides “value” to an institution, all are true except:

    1. (a)

      Improving patient satisfaction with pain control and postoperative recovery

    2. (b)

      Creating a competitive edge versus other anesthesia groups and surgery centers

    3. (c)

      Reducing perioperative costs by decreasing the acuity of patients recovering from surgery and ensuring same-day discharge

    4. (d)

      Immediately generating new revenue

  2. 2.

    The cause of prolonged post anesthesia recovery is:

    1. (a)

      Postoperative nausea and vomiting

    2. (b)

      Acute postoperative pain

    3. (c)

      Multifactorial

    4. (d)

      Acute chronic pain

  3. 3.

    According to the study by Macario and colleagues, which side effect from anesthesia do patients most prefer to avoid?

    1. (a)

      Vomiting

    2. (b)

      Nausea

    3. (c)

      Pain

    4. (d)

      Gagging on the endotracheal tube

  4. 4.

    When considering regional anesthesia “customers,” which of the following groups is most important?

    1. (a)

      Patients

    2. (b)

      Hospital administrators

    3. (c)

      Surgeons

    4. (d)

      Anesthesiology colleagues

  5. 5.

    Cost savings in the postoperative period attributable to regional anesthesia may result from all of the following except:

    1. (a)

      Reducing PACU length of stay

    2. (b)

      Avoiding unplanned hospitalization

    3. (c)

      Decreasing the patient to nurse ratio in PACU for bypass-eligible patients

    4. (d)

      Minimizing the need for pharmacologic interventions by PACU nurses

  6. 6.

    When designing the analgesic pathway for patients undergoing total knee arthroplasty, which of the following is false?

    1. (a)

      Intravenous patient-controlled opioid analgesia is typically administered on an inpatient basis.

    2. (b)

      Continuous nerve blocks may be managed effectively on an outpatient basis.

    3. (c)

      Epidural analgesia with local anesthetic solutions is most commonly maintained in the hospital setting.

    4. (d)

      None of the above.

  7. 7.

    Effectively billing for regional anesthesia procedures indicated for postoperative pain should involve which of the following?

    1. (a)

      Appropriate CPT coding.

    2. (b)

      Using a separate procedure note.

    3. (c)

      Including the distinct procedure modifier.

    4. (d)

      All of the above.

  8. 8.

    In a care team anesthesia delivery model, regional anesthesia may operate in the most efficient manner when:

    1. (a)

      Anesthesiologists are not familiar with regional anesthesia techniques

    2. (b)

      Equipment required for regional anesthesia is not centralized

    3. (c)

      Patients eligible for regional anesthesia are processed in “parallel”

    4. (d)

      Patients first learn about regional anesthesia on the day of surgery

  9. 9.

    When managing continuous nerve block catheters at home, which of the following is true?

    1. (a)

      Patients require a home nurse.

    2. (b)

      Patients must return to the hospital for catheter removal.

    3. (c)

      Patients should be called at home three times a day.

    4. (d)

      Patients should receive clear written and verbal instructions as well as contact information for a healthcare provider.

  10. 10.

    The clinical care team involved with managing patients with continuous regional anesthesia catheters should include:

    1. (a)

      Nursing

    2. (b)

      Pharmacists

    3. (c)

      Anesthesiologists

    4. (d)

      All of the above

  11. 11.

    Developing positive physician–nurse interactions when implementing a regional anesthesia program requires knowledge of all of the following except:

    1. (a)

      Collaboration

    2. (b)

      Assertiveness

    3. (c)

      Autonomy

    4. (d)

      Education

  12. 12.

    An nursing education program for regional anesthesia should include a discussion of:

    1. (a)

      Functional anatomy and physiology of nerve blockade

    2. (b)

      Expected effects of local anesthetics

    3. (c)

      Anticipated areas of pain not covered by blocks

    4. (d)

      All of the above

  13. 13.

    Nurses are most likely to call a physician about a regional anesthesia patient when:

    1. (a)

      They are familiar with the situation and suspect that something is wrong

    2. (b)

      They are bored

    3. (c)

      They are faced with a new situation beyond their comfort level and request guidance

    4. (d)

      (a) and (b)

  14. 14.

    Implementing a new regional anesthesia service requires all of the following except:

    1. (a)

      A master’s degree in business administration (x)

    2. (b)

      Specialized training in regional anesthesia

    3. (c)

      Teamwork

    4. (d)

      Effective communication

  15. 15.

    A “block room” requires all of the following except:

    1. (a)

      Oxygen source

    2. (b)

      Anesthesia machine (x)

    3. (c)

      Standard ASA monitors

    4. (d)

      Regional anesthesia supplies

  16. 16.

    Ambulatory patients discharged home after a single-injection peripheral nerve block with a long-acting local anesthetic:

    1. (a)

      Have reliable resolution of sensory and motor blockade within 12 h of block placement

    2. (b)

      Should receive a follow-up phone call the next week to assess for block resolution, adequacy of pain relief, and overall satisfaction with postoperative recovery

    3. (c)

      Should be discharged with a protective sling if they had an upper extremity block

    4. (d)

      Should be discharged home with a knee immobilizer if they had an adductor canal block

  17. 17.

    All of the following need to be completed prior to peripheral nerve block placement except:

    1. (a)

      Patient attends informational session prior to day of surgery that includes an introduction to regional anesthesia techniques employed.

    2. (b)

      Surgical consent and block consent signed by patient.

    3. (c)

      Anesthesia assessment completed.

    4. (d)

      Extremity to be blocked is marked by both surgeon and anesthesiologist.

  18. 18.

    New CPT codes for TAP blocks introduced in 2016:

    1. (a)

      Delineate between single injection and continuous infusion and unilateral or bilateral procedures

    2. (b)

      Include ultrasound imaging guidance

    3. (c)

      Can be used to bill for rectus sheath blocks

    4. (d)

      All of the above

  19. 19.

    Specialty training in regional anesthesiology techniques can be obtained:

    1. (a)

      During residency

    2. (b)

      By completing a Regional Anesthesiology and Acute Pain Fellowship

    3. (c)

      By taking continuing medical education courses dedicated to regional anesthesia

    4. (d)

      All of the above

  20. 20.

    Staffing a new regional anesthesia service includes training or hiring:

    1. (a)

      Anesthesiology physicians trained in regional techniques

    2. (b)

      Midlevel providers to assist with perioperative care and follow-ups

    3. (c)

      A separate billing specialist

    4. (d)

      (a) and (b)

Answers:

  1. 1.

    d

  2. 2.

    c

  3. 3.

    a

  4. 4.

    a

  5. 5.

    c

  6. 6.

    d

  7. 7.

    d

  8. 8.

    c

  9. 9.

    d

  10. 10.

    d

  11. 11.

    b

  12. 12.

    d

  13. 13.

    d

  14. 14.

    a

  15. 15.

    b

  16. 16.

    c

  17. 17.

    a

  18. 18.

    d

  19. 19.

    d

  20. 20.

    d

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Kurteva, S., Muse, I.O., Gritsenko, K. (2018). General Considerations for Regional Anesthesia Practice. In: Kaye, A., Urman, R., Vadivelu, N. (eds) Essentials of Regional Anesthesia. Springer, Cham. https://doi.org/10.1007/978-3-319-74838-2_1

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  • DOI: https://doi.org/10.1007/978-3-319-74838-2_1

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-74838-2

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