الفهرس 
Introduction for ambulatory SurgeryOnly 14 pages are availabe for public view
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Abstract
Ambulatory Surgery, sometimes called day case or outpatient surgery, in which the person comes to the hospital or ambulatory surgery facility the day of the surgery, has the operation, and goes home without an overnight stay in the hospital.
Ambulatory surgery has the potential to improve quality of care with low patient morbidity, and in a more demanding society where cost has an important role, ambulatory surgery has the potential to be the key in providing efficient surgical services.
Regional anesthesia techniques offer significant advantages for outpatient surgery. The use of local anesthetic techniques provides excellent analgesia without the side effects of opioids. The performance of peripheral nerve block for upper and lower extremity surgery provides intraoperative anesthesia and prolonged postoperative analgesia. Some of these blocks, especially in the lower extremities, can provide up to 24 hours of postoperative analgesia.
Patients undergoing regional anesthesia should expect the same standard of perioperative care as those who have undergone GA. However, regional anesthesia does bring unique advantages and problems to the ambulatory setting.
When selecting patient for ambulatory surgery under regional anesthesia we have to put in consideration the contraindications such as patient refusal, infection in the site of regional block, allergy to local anesthetic drugs, coagulopathy, and uncooperative patient.
The advantage of peripheral blockade can be extended further with the use of continuous perineural catheters, which are capable of providing postoperative analgesia for as long as 72 hours after major extremity surgery. Neuraxial blockade can also be useful in the outpatient setting. Spinal and epidural anesthesia can provide a high degree of alertness for surgery and a low incidence of nausea. All of these regional anesthesia techniques have significant usefulness in outpatient surgery, and multiple comparative studies have shown good pain relief, fast discharge, few complications and high patient satisfaction.
Ultrasound technology is rapidly evolving, and becoming increasingly more useful in the field of regional anesthesia. All studies comparing conventional techniques with ultrasound (US) guided techniques have found trend toward improved block characteristics with ultrasound guidance, including better quality of block, faster onset, and decreased block performance time.
In the past, surgical and anesthetic outcomes mainly referred to mortality and major morbidity. These are quite rare events, and thus investigators now focus their attention on less severe but more frequent clinical outcomes, such as minor surgical, medical and anesthetic complications. These outcomes are critically important for the quality evaluation of an ambulatory surgery programme, but they do not address issues of vital importance to patients and their families, such as respect and caring, or functional health status and quality of life.
Regional blockade provides optimal surgical conditions while providing prolonged postoperative analgesia. Patient safety, satisfaction, and quicker initial recovery are among the benefits of regional anesthesia.