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BJA Advance Access originally published online on July 8, 2009
British Journal of Anaesthesia 2009 103(3):428-433; doi:10.1093/bja/aep173
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© The Author [2009]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Comparison of economical aspects of interscalene brachial plexus blockade and general anaesthesia for arthroscopic shoulder surgery

C. Gonano, S. C. Kettner, M. Ernstbrunner, K. Schebesta, A. Chiari and P. Marhofer*

Department of Anaesthesia, Intensive Care Medicine and Pain Control, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria

* Corresponding author. E-mail: peter.marhofer{at}meduniwien.ac.at

Background: This study investigated the cost-effectiveness of ultrasonographic-guided interscalene brachial plexus blockade (ISB) in comparison with general anaesthesia (GA) for arthroscopic shoulder surgery.

Methods: Forty patients undergoing arthroscopic shoulder surgery received either an ultrasonographic-guided ISB or GA. ISB was performed outside the operation room (OR) and patients were transferred in the OR at the earliest 20 min after block performance. All drugs and disposables were recorded to evaluate the costs for both techniques. The following anaesthesia-related times were defined: ready for surgical preparation (from arrival in the OR until end of anaesthesia induction), OR emergence time (from end of dressing until leaving the OR), anaesthesia control time (from patient's arrival in the OR until readiness for positioning plus time from the end of surgery to patient's discharge from the OR), and post-anaesthesia care unit (PACU) time (from patient's arrival in the PACU to the eligibility for discharge to normal ward). Personnel costs were excluded from statistical analysis.

Results: The total costs were [mean (SD)] 33 (9){euro} for patients with ISB and 41 (7){euro} for those who received GA (P<0.01). The anaesthesia-related workflow was improved in the ISB group when compared with the GA group [ready for surgical preparation 8 (3) vs 13 (5) min, P<0.001; OR emergence time 4 (3) vs 10 (5), P<0.001; anaesthesia control time 12 (4) vs 23 (6), P<0.001; and PACU time 45 (17) vs 70 (20), P<0.001].

Conclusions: Ultrasonographic-guided ISB is a cost-effective method for arthroscopic shoulder surgery.

Keywords: anaesthesia, general; anaesthetic techniques, regional, brachial plexus; economics, medical; efficiency, organizational


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E-letters:

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ECONOMIC ASPECTS OF REGIONAL ANAESTHESIA
Brian A. Williams, et al.
British Journal of Anaesthesia, 21 Jul 2009 [Full text]
Response to the Letter by Williams et al.
Peter Marhofer
British Journal of Anaesthesia, 12 Aug 2009 [Full text]
Interscalene block combined with general anaesthesia can be more cost effective than either technique alone
Michael J Fredrickson
British Journal of Anaesthesia, 9 Sep 2009 [Full text]
Economical aspects of different anaesthesia methods should be compared but it has to be done properly
José Aguirre, et al.
British Journal of Anaesthesia, 2 Oct 2009 [Full text]

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