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A renewed interest in the treatment of postoperative pain, together
with the need for expedient operating room management, creates a
professional mandate for the development of safe anesthetic alternatives to
the ubiquitous general anesthesia. It is well documented that regional
anesthesia helps to decrease opioid-related side effects, facilitates the
bypass of the postanesthesia care unit, shortens the turnover times,
facilitates early patient discharge, and decreases the risk of unanticipated
hospital admissions.1–5 However, a variety of factors germane to the private
practice of anesthesiology hinders the wider application of a regional
anesthesia-driven service to the community setting. These factors include
increased production pressure due to an accelerated surgical pace and volume
and a demand for efficiency. In addition, the lack of resources, a shortfall
in assistance, and the capricious state of third-party reimbursement often
force the specialty to question whether these services can be implemented
and offered in a community setting.
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Establishment of an effective service involves changing the existing
medical practice culture. This change can be accomplished only by
effectively communicating the measurable advantages of newer techniques to
patients, surgeons, and other medical and anesthesia colleagues. With the
assistance of written orders and flow sheets, nurses are empowered to assume
an important role in assessing and caring for the inpatient with a regional
anesthetic. Collaboration with other disciplines (internal medicine,
surgery, and physical therapy) ensures that lapses in care are avoided.
Extending the unparalleled analgesic benefits of regional anesthesia to the
outpatient setting further expands the range of surgical procedures performed and
facilitates home readiness.
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Spreading the Word to Patients
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In their survey results, Matthey and coworkers1 found
reasons why patients avoid regional anesthetics and confirmed that patients'
perceptions of regional anesthesia were greatly distorted. Fears of being
awake during surgery, experiencing pain during the procedure, needle
placement, back injury, and paralysis constituted the main unfounded reasons
why patients opted for general anesthesia.1 The efforts of
anesthesiologists have been inadequate in correcting these misconceptions
and addressing patient's concerns. Converting such misconceptions into a greater
acceptance of regional anesthesia involves an organized approach to
educating patients. The preoperative anesthesia visit is an ideal
opportunity for the anesthesia care team to discuss expectations and assuage
these fears.
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Delineating the advantages of regional anesthesia combined with
assurances that patients can be made comfortable during administration of
the regional anesthetic or asleep throughout the surgical procedure
effectively addresses a patient's primary preoccupation with hearing,
feeling, or seeing the anesthesia procedure or surgery. Preprinted pamphlets
and a patient instruction sheet help to reinforce the information
disseminated during the preoperative anesthesia interview.
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An example of a particularly effective tool for educating patients is a
class given by the orthopedic nursing staff for patients considering joint
replacement surgery. As part of a patient education seminar, monthly
hour-long classes are given in our institution. Topics can include all major
aspects of a typical hospital stay ...