Introduction
Pediatric ambulatory surgery is the dominant model of surgical care in the U.S. and has impacted the practice of regional anesthesia (RA). Pediatric RA’s use has expanded as a supplement to general anesthesia with the introduction of ultrasound. We wish to document RA practice changes over the last 14 years in our ambulatory surgery center (ASC).
Methods
A retrospective review of RA practice from 7/2010 to 12/2024 at a free-standing pediatric ASC was performed. A commercial software system extracted de-identified, aggregated health data from the system’s EMR. Using statistical process control methods, data were processed to distinguish between common and special cause variation.
Results
Incidence of peripheral nerve blocks (PNB) was 13% and increased to 35.4% (associated with ultrasound use and pudendal block standard for penile surgery). The inverse was seen with central neuraxial block (CNB), dropping from 10% of cases to 2%. At baseline 25% of cases received a single injection block, increasing three-fold (associated with ultrasound/pudendal introductions, COVID-related reduction in non-regional cases, and non-regional case volume recovery). The incidence of continuous catheter cases was 3.7% and decreased twice (associated with COVID and sports medicine catheter program closure). Anesthesia preparation time with RA decreased from 16.8 to 12.5 min (associated with ultrasound introduction, end of COVID restrictions, and sports medicine catheter program closure). The first attempt RA success rate was high (PNB-90%, CNB-83%; single injection-89%, continuous catheter-96%). PACU maximum pain and opioid use rates decreased for RA and non-RA patients. Wrong-site blocks, their root cause analyses, and improvements to the RA timeout are discussed.
Discussion
This review’s key findings include an evolution in RA practice, which in conjunction with opioid-sparing efforts, have driven improvements in clinical outcomes. Our ambulatory pediatric RA practice may not reflect practice seen in others; thus, we do not make inferences outside our facility.