J Med Assoc Thai 2017; 100 (9):166

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A Block Room in Parallel Processing Shortens the Anesthesia Utilization Time in Orthopedic Operating Rooms; A Prospective Cross-Sectional Study
Tangwiwat S Mail, Iamaroon A , Lurngnateetape A , Chareancholvanich K , Nuntawinit C , Imkong P

Objective: Regional anesthesia (RA) can be time consuming, thus interfering with surgical schedule. We hypothesized that running a block room simultaneously to the operating routine accelerates the anesthesia related timing, and as a consequence, improving the utilization of operating rooms (OR).
Material and Method: After Institutional Review Board (IRB) approval, a prospective study was performed from January until June 2012 including extremity orthopedic operations. Parallel to the ORs a ‘block room’ was run by an anesthetic team to apply regional/neuraxial blocks. Demographic characteristics, anesthesia techniques, anesthesia utilization time, surgical preparation time, and operation turn over time were recorded. We also recorded the first case on-time starts (9 am) and the number of cases running overtime (4 pm).
Results: During the investigation period 854 (53.9%) out of 1,585 extremities orthopedic procedures had sole regional anesthesia (RA), 224 (14.1%) regional blocks combined with general anesthesia (GA and RA) and 507 (32.0%) general anesthesia (GA alone). Regional blocks were performed in either a separate block room (11.7%) or the OR (42.2%). Compared to the usual schedule the availability of a block room significantly reduced the anesthesia utilization time (12 vs. 29 minutes, p<0.01) but not the turnover time (5 vs. 10 minutes, p = 0.12). RA inside OR and GA with RA led up to longer anesthesia-controlled time than GA alone (29 vs. 38 vs. 27 minutes, p<0.01). First-case on-time starts (9 am) occurred only in 26.3%. Cases running overtime were 47%; most of them (96.2%) ending at 4 to 6 pm.
Conclusion: Using a block room in orthopedic surgery as additional work station resulted in reduced perioperative anesthesia-controlled time. Time consumption for RA inside OR was longer than for sole GA. Turnover time was rather unaffected by anesthetic techniques. Future studies should investigate if and how using a block room can improve OR productivity without financial damage.

Parallel system, Regional anesthesia block room, Anesthesia utilization time, Operating room turnover time

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