Making an ambulatory surgery centre suitable for regional anaesthesia

This chapter reviews a management strategy for transforming an outpatient surgery centre from that which exclusively uses general anaesthesia to one using regional anaesthesia with peripheral nerve blocks. Barriers presented by patients, nursing staff, surgeons and administrators can be notable; these might undermine the well-intended efforts of highly-skilled regionalists. Clearly, understanding the process benefits from the time the patient enters the facility until discharge home is essential, especially when presenting requests for support from facility administrators. Using a team approach is a logical place to start, as is defining new quality indicators and tracking patient outcomes. The centrepiece of the anaesthesia care process remains pre-emptive multimodal analgesia, routine multimodal anti-emetic prophylaxis and avoidance of general anaesthesia (GA) with volatile agents. The remainder of the care process relies on teamwork among all healthcare providers and meaningful administrative support.