Obstetric postanesthesia care unit stays - Reevaluation of discharge criteria after regional anesthesia

Background Obstetric patients may have long postanesthesia care unit (OB-PA CU) stays after surgery because of residual regional block or other conditi ons. This study evaluated whether modified discharge criteria might allow f or earlier discharge without compromising patient safety. Methods: Data were prospectively collected for 6 months for all patients (N = 358) who underwent cesarean section or tubal ligation and recovered in t he OB-PACU. Regional anesthesia was used in 94% of patients. The duration o f anesthesia and PACU stays, the presence and treatment of events in the PA CU, and the regression of neural blockade were recorded. Discharge from the OB-PACU required a GO-min minimum stay, stable vital signs, adequate analg esia, and ability to flex the knees. After completion of prospective data c ollection, events that kept patients in the PACU after 60 min were reevalua ted as to whether patients needed to stay Ln the PACU for medical reasons. "Needed to stay" events included bleeding, cardiorespiratory problems, seda tion, dizziness, and pain. "Safe to leave" conditions included pruritus, na usea, and residual neural blockade. The cumulative duration of OB-PACU stay s not clearly justifiable for medical reasons was calculated. Results: Residual block and spinal opioid side effects accounted for the ma jority of "unnecessary" stays. Annually, 429 h of PACU time could have been saved using the revised criteria. Complications did not develop subsequent ly in any patient deemed "safe to leave." Conclusions: In many obstetric patients, the duration of PACU stays could s afely be shortened by continuing observation in a lower-acuity setting. Thi s may result in greater flexibility and more efficient use of nursing perso nnel.