Cr. Chilvers et al., PHARMACOECONOMICS OF INTRAVENOUS REGIONAL ANESTHESIA VS GENERAL-ANESTHESIA FOR OUTPATIENT HAND SURGERY, Canadian journal of anaesthesia, 44(11), 1997, pp. 1152-1156
Purpose: To compare the cost and effectiveness of intravenous regional
anaesthesia (IVRA) with general anaesthesia (GA) for outpatient hand
surgery. Method: A retrospective record analysis of 121 patients who r
eceived IVRA were compared with 64 patients who received GA in our Day
care centre. The costs of anaesthesia and recovery were calculated fro
m an institutional perspective using 1995 Canadian Dollar values. Effe
ctiveness was measured in terms of time for anaesthesia, recovery and
discharge, % with unsatisfactory anaesthesia and complications. Result
s: Both groups were well matched in terms of weight, sex and ASA class
, Patients in the IVRA group were older (45 +/- 16 vs 38 +/- 13 yr) an
d had a lower frequency of two types of operation. The median total co
st for the IVRA group of $24.60 (15.76-55.29) was less than that for t
he GA group of $48.66 (35.59-73.11), (P < 0.00001). Anaesthesia was un
satisfactory in 11% of the IVRA group, but in none having GA, (P < 0.0
1). Recovery was faster in the IVRA group with a median time to discha
rge of 70 (35-180) min compared with 118 (45-320) min in the GA group,
(P < 0.00001). Vomiting requiring treatment occurred in 5% of the GA
group, but in none having IVRA, (P < 0.05). Dizziness which delayed di
scharge also occurred in 5% of the GA group, but in none having IVRA,
(P < 0.05). Conclusion: The cost of anaesthesia and recovery using IVR
A for outpatient hand surgery was half that of GA, intravenous regiona
l anaesthesia was less effective than GA in achieving satisfactory ana
esthesia, equally effective in time to administer anaesthesia, and mor
e effective in speeding recovery and minimising postoperative complica
tions.