to build about the mortality and morbidity benefits of the technique.
Spinal blocks have to be tailored to the surgeon, says Dr.
McCartney, who explains lower doses of a spinal anesthetic can be
used to encourage early recovery if surgeons can perform proce-
dures in less than an hour. "But if you give a full spinal during
quicker cases, the patient may not be able to stand and move
around until 5 hours after surgery," he adds.
Some surgeons believe that early ambulation predicts early dis-
charge, but Dr. McCartney says there's actually no evidence in the lit-
erature that proves that's true. Pain control is a better predictor, and
that's where regional has the advantage, he adds.
"Unfortunately, pain control benefit isn't a big enough argument
for most clinicians," says Dr. McCartney, who suggests you consider
lower rates of major morbidity and mortality — which ultimately
reduce overall healthcare costs — and the potential for greater effi-
ciency. If you can discharge patients earlier or use a model where
the spinal block is done outside the OR, you could potentially add
an extra case per day.
Regional is also a safer alternative for older, sicker patients who are
most likely to seek out facilities that perform same-day knee replace-
ments. In the end, regional results in a better experience. "There's no
question that if it was my knee replacement, I'd have a spinal every
time," says Dr. McCartney. OSM
E-mail dcook@outpatientsurgery.net.
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