Clinical Orthopaedics and Related Research®

, Volume 472, Issue 5, pp 1427–1433 | Cite as

Is Regional Anesthesia Associated With Reduced PACU Length of Stay?

A Retrospective Analysis From a Tertiary Medical Center
  • John M. Corey
  • Catherine M. Bulka
  • Jesse M. Ehrenfeld
Symposium: Perioperative Pain Management in Orthopaedic Surgery



Postanesthesia care is a costly component of overall surgical care. In the ambulatory setting, regional anesthesia has been shown for multiple surgical procedures to either decrease postanesthesia care unit (PACU) length of stay (LOS) or completely bypass it altogether. This has not been demonstrated in a large hospital setting with a complex surgical case mix.


We therefore determined whether regional anesthesia was associated with a reduced PACU LOS among patients undergoing inpatient and outpatient surgery in a large tertiary-care teaching hospital. Secondary study questions included risk factors for longer PACU LOS and any possible interaction between regional and general anesthesia as it might have affected PACU LOS.


We performed a matched retrospective study on patients who had surgery at our institution and were admitted to the PACU immediately after leaving the operating room. We analyzed between January 1, 2005, and January 1, 2013, with one cohort receiving regional anesthesia, with or without general anesthesia, and the other receiving no regional anesthesia. We measured the association between regional anesthesia and time to successful PACU discharge using a Cox multivariate proportional-hazards model.


After controlling for potentially confounding variables, including patient age, American Society of Anesthesiologists’ physical classification, and duration of surgery (using multivariate analysis), there was no difference in the time to successful PACU discharge between patients who received regional anesthesia and those who did not. However, when compared to those who received general anesthesia, regional anesthesia was associated with decreased PACU LOS. Further, there was significant effect modification between regional and general anesthesia; patients who received both regional and general were more likely to be successfully discharged faster from the PACU than patients who received only general anesthesia (hazard ratio = 1.50, 95% CI = 1.46–1.55, p < 0.001).


We demonstrated that independently, regional anesthesia is not associated with a reduced PACU LOS in an unselected population at a large tertiary-care hospital, but regional is favored when compared to general anesthesia. Whether the differences are clinically important, and in what procedures they are most pronounced, would be reasonable questions for future prospective comparative trials.

Level of Evidence

Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.


Regional Anesthesia Postanesthesia Care Unit Monitor Anesthesia Care Monitor Anesthesia Care Clinical Classification Software 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49:924–934.PubMedGoogle Scholar
  2. 2.
    Buchanan FF, Myles PS, Cicuttini F. Effect of patient sex on general anaesthesia and recovery. Br J Anaesth. 2011;106:832–839.PubMedCrossRefGoogle Scholar
  3. 3.
    Carli F, Kehlet H, Baldini G, Steel A, McRae K, Slinger P, Hemmerling T, Salinas F, Neal JM. Evidence basis for regional anesthesia in multidisciplinary fast-track surgical care pathways. Regional Anesth Pain Med. 2011;36:63–72.CrossRefGoogle Scholar
  4. 4.
    Dexter F, Tinker JF. Analysis of strategies to decrease postanesthesia care unit costs. Anesthesiology. 1995;82:94–101.PubMedCrossRefGoogle Scholar
  5. 5.
    Gouvas N, Tan E, Windsor A, Xynos E, Tekkis PP. Fast-track vs standard care in colorectal surgery: a meta-analysis update. Int J Colorectal Dis. 2009;24:1119–1131.PubMedCrossRefGoogle Scholar
  6. 6.
    Hadzic A, Kerimoglu B, Loreio D, Karaca PE, Claudio RE, Yufa M, Wedderburn R, Santos AC, Thys DM. Paravertebral blocks provide superior same-day recovery over general anesthesia for patients undergoing inguinal hernia repair. Anesth Analg. 2006;102:1076–1081.PubMedCrossRefGoogle Scholar
  7. 7.
    Hadzic A, Williams BA, Karaca PE, Hobeika P, Unis G, Dermksian J, Yufa M, Thys DM, Santos AC. For outpatient rotator cuff surgery, nerve block anesthesia provides superior same-day recovery over general anesthesia. Anesthesiology. 2005;102:1001–1007.PubMedCrossRefGoogle Scholar
  8. 8.
    Healthcare Cost and Utilization Project (HCUP). HCUP Clinical Classifications Software (CCS) for ICD-9-CM, 2006–2009. Available at: Accessed May 1, 2013.
  9. 9.
    Husted H, Jensen CM, Solgaard S, Kehlet H. Reduced length of stay following hip and knee arthroplasty in Denmark 2000–2009: from research to implementation. Arch Orthop Trauma Surg. 2012;132:101–104.PubMedCrossRefGoogle Scholar
  10. 10.
    Ilfeld BM, Ball ST, Gearen PF, Le LT, Mariano ER, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, Theriaque DW, Meyer RS. Ambulatory continuous posterior lumbar plexus nerve blocks after hip arthroplasty: a dual-center, randomized, triple-masked, placebo-controlled trial. Anesthesiology. 2008;109:491–501.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Ilfeld BM, Le LT, Meyer RS, Mariano ER, Vandenborne K, Duncan PW, Sessler DI, Enneking FK, Shuster JJ, Theriaque DW, Berry LF, Spadoni EH, Gearen P. Ambulatory continuous femoral nerve blocks decrease time to discharge readiness after tricompartment total knee arthroplasty: a randomized, triple-masked, placebo-controlled study. Anesthesiology. 2008;108:703–713.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Lassen K, Soop M, Nygren J, Cox PB, Hendry PO, Spies C, von Meyenfeldt MF, Fearon KC, Revhaug A, Norderval S, Ljungqvist O, Lobo DN, Dejong CH; Enhanced Recovery After Surgery (ERAS) Group. Consensus review of optimal perioperative care in colorectal surgery: Enhanced Recovery After Surgery (ERAS) Group recommendations. Arch Surg. 2009;144:961–969.PubMedCrossRefGoogle Scholar
  13. 13.
    Leslie K, Myles PS, Forbes A, Chan MT, Short TG, Swallow SK. Recovery from bispectral index-guided anaesthesia in a large randomized controlled trial of patients at high risk of awareness. Anaesth Intensive Care. 2005;33:443–451.PubMedGoogle Scholar
  14. 14.
    Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg. 2005;101:1634–1642.PubMedCrossRefGoogle Scholar
  15. 15.
    Lunn TH, Kristensen BB, Gaarn-Larsen L, Husted H, Kehlet H. Post-anaesthesia care unit stay after total hip and knee arthroplasty under spinal anaesthesia. Acta Anaesth Scand. 2012;56:1139–1145.PubMedCrossRefGoogle Scholar
  16. 16.
    Pencina MJ, D’Agostino RB. Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation. Stat Med. 2004;23:2109–2123.PubMedCrossRefGoogle Scholar
  17. 17.
    Seago JA, Weitz S, Walczak S. Factors influencing stay in the postanesthesia care unit: a prospective analysis. J Clin Anesth. 1998;10:579–587.PubMedCrossRefGoogle Scholar
  18. 18.
    Waddle JP, Evers AS, Piccirillo JF. Postanesthesia care unit length of stay: quantifying and assessing dependent factors. Anesth Analg. 1998;87:628–633.PubMedGoogle Scholar
  19. 19.
    Williams BA, Motolenich P, Kentor ML. Hospital facilities and resource management: economic impact of a high-volume regional anesthesia program for outpatients. Int Anesthesiol Clin. 2005;43:43–51.PubMedCrossRefGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2013

Authors and Affiliations

  • John M. Corey
    • 1
  • Catherine M. Bulka
    • 1
  • Jesse M. Ehrenfeld
    • 1
  1. 1.Department of Anesthesiology and Pain MedicineVanderbilt University Medical CenterNashvilleUSA

Personalised recommendations