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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.

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.

Spreading the Word to Patients

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.

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.

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 ...

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