PHARMACOECONOMICS OF INTRAVENOUS REGIONAL ANESTHESIA VS GENERAL-ANESTHESIA FOR OUTPATIENT HAND SURGERY

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.