Regionalanästhesie im klinischen Alltag: eine ökonomische Analyse anhand eines Versorgungsbeispiels

Die Gesundheitsausgaben in den meisten Ländern steigen stetig, trotzdem werden fundierte wissenschaftliche Artikel zum Thema Medizinökonomie selten publiziert. Dies gilt auch für das Fachgebiet der Anästhesie sowie deren Subspezialitäten. Insbesondere die Regionalanästhesie hat sich hier während der letzten Jahre kontinuierlich weiterentwickelt, und die Implementierung des Ultraschalls hat zur Effizienzsteigerung auf diesem Gebiet entscheidend beigetragen. Der vorliegende Artikel analysiert anhand von 3 Fallvignetten (anästhesiologische Versorgung einer Unterarmfraktur in suffizienter Regionalanästhesie, Allgemeinnarkose und insuffizienter Regionalanästhesie) die ökonomischen Implikationen der verschiedenen anästhesiologischen Verfahren. Entsprechende Maßnahmen zur erfolgreichen ökonomisch orientierten Implementierung der Regionalanästhesie in den klinischen Alltag werden in diesem Artikel besprochen. The economic effect is a crucial aspect of every medical procedure. This article analyzes the economic implications of various methods in anesthesia based on three case vignettes. Methods The management of anesthesia of a forearm fracture with sufficient brachial plexus blockade, general anesthesia and insufficient brachial plexus blockade with subsequent general anesthesia was analyzed with respect to the relevant cost factors (personnel costs, durables, consumables, fixed assets costs, anesthesia-related overhead costs). Results Sufficient regional anesthesia was the least expensive method for a forearm fracture with 324.26 €, followed by general anesthesia with 399.18 € (+23% compared with regional anesthesia). Insufficient regional anesthesia was most the expensive method, which necessitated an additional general anesthesia (482.55 €, +49% compared with sufficient regional anesthesia). Conclusion Even considering that this cost analysis was calculated based on data from only one medical institution (General Hospital of Vienna, Medical University of Vienna), regional anesthesia appeared to be cost efficient compared with other anesthesia procedures. Main cost drivers in this example were personnel costs

Dexamethasone as an adjuvant for peripheral nerve blockade: a randomised, triple-blinded crossover study in volunteers

Background The efficacy of dexamethasone in extending the duration of local anaesthetic block is uncertain. In a randomised controlled triple blind crossover study in volunteers, we tested the hypothesis that neither i.v. nor perineurally administered dexamethasone prolongs the sensory block achieved with ropivacaine. Methods Ultrasound-guided ulnar nerve blocks (ropivacaine 0.75% wt/vol, 3 ml, with saline 1 ml with or without dexamethasone 4 mg) were performed on three occasions in 24 male volunteers along with an i.v. injection of saline 1 ml with or without dexamethasone 4 mg. The combinations of saline and dexamethasone were as follows: control group, perineural and i.v. saline; perineural group, perineural dexamethasone and i.v. saline; i.v. group, perineural saline and i.v. dexamethasone. Sensory block was measured using a VAS in response to pinprick testing. The duration of sensory block was the primary outcome and time to onset of sensory block the secondary outcome. Results All 24 subjects completed the trial. The median [inter-quartile range (IQR)] duration of sensory block was 6.87 (5.85–7.62) h in the control group, 7.37 (5.78–7.93) h in the perineural group and 7.37 (6.10–7.97) h in the i.v. group (P=0.61). There was also no significant difference in block onset time between the three groups. Conclusion Dexamethasone 4 mg has no clinically relevant effect on the duration of sensory block provided by ropivacaine applied to the ulnar nerve. Clinical trial registration DRKS, 00014604; EudraCT, 2018-001221-98