Li et al.1010 Li LT, Bokshan SL, Levins JG, et al. Cost Drivers Associated With Anterior Shoulder Stabilization Surgery. Orthop J Sports Med. 2020;8:2325967120926465.
|
NR |
3,903 |
15,670 |
Loco-regional anesthesia |
NR |
1,576 |
19,929 |
Average total costs were significantly higher in patients undergoing regional anesthesia. |
Several other contributors to higher costs are described. |
Medical procedure costs |
Bokshan et al.1111 Bokshan SL, Mehta S, DeFroda SF, et al. What Are the Primary Cost Drivers of Anterior Cruciate Ligament Reconstruction in the United States? A Cost-Minimization Analysis of 14,713 Patients. Arthroscopy. 2019;35:1576–81.
|
NR |
3,737 |
19,249 |
Loco-regional anesthesia |
NR |
10,976 |
17,469 |
Average total costs were significantly lower in patients undergoing regional anesthesia. |
General anesthesia, Hispanic ethnicity, Chronic medical condition, male gender, operative time and age are predictors of increased costs. |
Medical procedure costs |
Gebhardt et al.1212 GebhardtV, ZawieruchaV, Schöffski O, et al. Spinal anaesthesia with chloroprocaine 1% versus total intravenous anaesthesia for outpatient knee arthroscopy: A randomised controlled trial. Eur J Anaesthesiol. 2018;35:774–81.
|
Sulfentanil and Propofol |
25 |
71.92 |
SA |
Chloroprocaine 25 1% |
41.02 |
Anesthesia costs are inferior in case of regional anesthesia. |
Spinal had faster recovery with patients reaching discharge earlier (117 vs. 142 min)*. Pain occurred earlier in the general anesthesia group. Patients felt significantly more uncomfortable after general anesthesia. |
Anesthesia costs |
Hamilton et al.1313 Hamilton GM, Ramlogan R, Lui A, et al. Association of peripheral nerve blocks with postoperative outcomes in ambulatory shoulder surgery patients: a single-centre matched-cohort study. Can J Anaesth. 2019;66:63–74.
|
Volatile anesthetics or intravenous with propofol |
241 |
60 |
Interscalene brachial plexus single shot block, or catheter |
20–40 mL of 0.5% ropivacaine with 1:400,000 epinephrine |
1,382 |
82 |
No statistically significant difference between groups. |
Increased risk of an emergency department visit within 30 days for patients who received a regional anesthesia. |
Costs incurred after surgery |
Chandran et al.1414 Chandran D, Woods CM, ScharM, et al. Cost analysis of injection laryngoplasty performed under local anaesthesia versus general anaesthesia: an Australian perspective. J Laryngol Otol. 2018;132:168–72.,
|
NR |
6 |
2071 |
LA |
NR |
14 |
1251 |
Average total costs of injection laryngoplasty under LA are significantly lower than under GA with cost savings of 40%. Major contributors are direct and indirect operating theater costs. |
Length of stay (h): 8.8 GA vs 6.4 LA
|
Medical procedure costs |
Camponovo et al.1515 Camponovo C. Spinal 1% 2-Chloroprocaine versus general anesthesia for ultra-short outpatient procedures: a retrospective analysis. Acta Biomed. 2014;85:265–8.
|
Intravenous propofol and fentanyl |
28 |
104 |
SA |
Chloroprocaine 1% |
28 |
63 |
SA for knee arthroscopy is associated with cost reductions per patient compared with GA. Cost reductions in the SA group are due to: the ability to systematically bypass the PACU, faster discharge time, the lower incidence of pain and postoperative nausea and vomiting. |
Anesthesia time: 64 vs. 62 min. Discharge time: 326 (GA) vs 203 min (SA)
|
Anesthesia supplies, drugs, staff |
Penketh et al.1616 Penketh RJ, Bruen EM, White J, et al. Feasibility of resectoscopic operative hysteroscopy in a UK outpatient clinic using local anesthetic and traditional reusable equipment, with patient experiences and comparative cost analysis. J Minim Invasive Gynecol. 2014;21:830–6.
|
NR |
NR |
1,485 |
LA in operatory room LA in office |
NR |
NR |
LA in operatory room: 716 LA in office: 482 |
Operative hysteroscopic resection under LA is less expensive than under GA, especially if performed in the office compared to the OR.
Reduced staff costs are the primary reason for saving.
|
NR |
Medical procedure costs |
Sivalingam et al.1717 Sivalingam S, Tamm-Daniels I, Nakada SY. Office-based ureteral stent placement under local anesthesia for obstructing stones is safe and efficacious. Urology. 2013;81:498–502.
|
NR |
73 |
30,060 |
LA |
Lidocaine 1%
|
46 |
7,770 |
Average total cost is nearly 4 times greater for the GA group compared to LA. Ureteral stent placement can be safely and effectively performed under LA in the office. |
No difference in complications between GA and LA. |
Medical procedure costs |
Ahonkallio et al.1818 Ahonkallio S, Santala M, Valtonen H, et al. Cost-minimisation analysis of endometrial thermal ablation in a day case or outpatient setting under different anaesthesia regimens. Eur J Obstet Gynecol Reprod Biol. 2012;162:102–4.,
|
NR |
20 |
2,333 |
Peripheral block |
20 mL ropivacaine 2mgmL−1,
|
16 |
1,333 |
Endometrial thermal ablation under PB is cheaper than GA and results in significantly reduced health service costs. The difference is due to lower costs of the hospital ward and anesthesia, and partly to overhead costs. |
NR |
Medical procedure costs |
Covarelli et al.1919 Covarelli P, Badolato M, Tomassini GM, et al. Sentinel lymph node biopsy under local anaesthesia versus general anaesthesia: reliability and cost-effectiveness analysis in 153 patients with malignant melanoma. In Vivo. 2012;26:315–8.,
|
NR |
41 |
373 |
LA |
10–25mL 1% mepivacaine and 0.5% L-bupicavaine in equal parts |
112 |
258 |
Average total costs for groin and axillary sentinel lymph node biopsy under GA are significantly higher than those under LA. |
No differences in the number of complications. |
Operating room management, personnel, drugs, instruments |
Stoffels et al.2020 Stoffels I, Dissemond J, Körber A, et al. Reliability and cost-effectiveness of sentinel lymph node excision under local anaesthesia versus general anaesthesia for malignant melanoma: a retrospective analysis in 300 patients with malignant melanoma AJCC Stages I and II. J Eur Acad Dermatol Venereol. 2011;25:306–10.
|
NR |
89 |
500 |
LA |
450 mL physiological solution, 50 mL
Lidocain 1%, 0.5 mg Epinephrin
|
211 |
47 |
The costs were significantly less in a procedures room performed under local anesthesia compared to general anesthesia in an operating room. |
No differences in the number of postoperative complications nor in oncological outcomes. |
Anesthesia costs |
Mitchell et al.2121 Mitchell PJ, Cattle K, Saravanathan S, et al. Insertion under local anaesthetic of temporary electrodes for sacral nerve stimulation testing is reliable and cost effective. Colorectal Dis. 2011;13:445–8.,
|
NR |
64 |
1,244 |
LA |
NR |
47 |
1,026 |
Sacral nerve stimulation under LA is associated with reduced costs compared to GA. |
LA is associated with shorter hospital stay and quicker recovery.
Similar symptom score and success rate for both anesthesia.
|
Medical procedure costs |
Kushwaha et al.2222 Kushwaha R, Hutchings W, Davies C, et al. Randomized clinical trial comparing day-care open haemorrhoidectomy under local versus general anaesthesia. Br J Surg. 2008;95:555–63.
|
Propofol 1.5–2mgkg−1 and fentanyl 10 μg kg−1 with sevoflurane
|
22 |
714 |
LA |
20mL 1% lidocaine with 1:10,000 epinephrine |
19 |
503 |
Excluding the cost of post-operative follow-up, LA was 1.5 times cheaper than GA. This difference is due to the saving in GA and recovery room costs. |
LA is associated with similar tolerance and clinical outcome compared to GA. |
Suture materials, drugs, day surgery bed, staff costs, recovery room, postoperative medication. |
Mostafa et al.2323 Mostafa H, el-Shamaa H, el-Refaai N, et al. Randomized double blind comparison between sciatic-femoral nerve block and propofol-remifentanil, propofol-alfentanil general anesthetics in out-patient knee arthroscopy. PakJ BiolSci. 2008;11:359–65.
|
Intravenous remifentanil 0.5 μg kg−1 min−1 or alfentanil 2 μg kg−1 min−1 and propofol 9 mg kg−1 h−1
|
40 |
492 for remifentanil 541 for alfentanil |
Sciatic-femoral nerve block |
25 mL ropivacaine |
20 |
393 |
Costs of disposals, pre-operative and postoperative times are higher for the sciatic-femoral block group, however average total costs (including also drugs) are insignificant between GA and sciatic-femoral nerve block. |
Length of stay in PACU: 28 min for remifentanil GA vs 25 min for alfentanil GA vs 28 for sciatic-femoral nerve block |
Disposal, drugs, staff |
Horn et al.2424 Horn JL, Swide C, Gaebel BA, et al. Comparison of efficiency, recovery profile and perioperative costs of regional anaesthesia vs. general anaesthesia for outpatient upper extremity surgery. Eur J Anaesthesiol. 2007;24:557–9.,
|
Propofol with sevoflurane or desflurane, fentanyl or sufentanyl |
121 |
4,780 |
Peripheral nerve block |
Mepivacaine 1.5% with 10% sodium bicarbonate |
92 |
3,656 |
Perioperative costs in the peripheral nerve block group are significantly lower than in the GA group. |
PACU time: 49 min (GA) vs 15min (PNB)
|
Medical procedure costs |
The use of peripheral nerve block in upper extremity surgery is feasible and associated to significant cost savings. |
Postoperative complications: 11.7% (GA) vs 3.3% (PNB)
|
Nishikawa et al.2525 Nishikawa K, Yoshida S, Shimodate Y et al. A comparison of spinal anesthesia with small-dose lidocaine and general anesthesia with fentanyl and propofol for ambulatory prostate biopsy procedures in elderly patients. J Clin Anesth. 2007;19:25–9.
|
Intravenous fentanyl 1 μg kg−1 and propofol 6mgkg−1 h−1
|
40 |
74 |
SA |
Lidocaine 1% 1 m L |
40 |
49 |
Average total costs are significantly lower in the SA group. Costs of drugs and supplies used in the operatory room are reduced for the SA, whereas the labor costs are higher in both operatory room and recovery unit. |
Time to home-readiness: 30 min (GA) vs 38 min (SA)* No pain in the recovery unit for 75% patients in GA vs 80% patients SA groups.* |
Drugs, equipment, staff |
SA may be a suitable cost-effective alternative to GA for elderly ambulatory prostate biopsy. |
No adverse events at home. |
Nordin et al.2626 Nordin P, Zetterström H, Carlsson P, et al. Cost-effectiveness analysis of local, regional and general anaesthesia for inguinal hernia repair using data from a randomized clinical trial. Br J Surg. 2007;94:500–5.,
|
NR |
199 |
2,964 |
SA/epidural anesthesia
LA
|
SA/epidural anesthesia: NR
LA: 50:50 mixture of 1% mepivacaine and 0.5% bupicavaine
|
SA/epidural anesthesia: 164/35 = 199
LA: 205
|
SA/epidural anesthesia: 3,010
LA: 2,508
|
Average total costs of LA are significantly lower than the other two groups.
Intra-operative (anesthetic equipment, duration of surgery and anesthesia) and post-operative (time in recovery room, unplanned overnight admission) costs are reduced for LA compared to SA/epidural anesthesia and GA. No difference between SA/epidural anesthesia and GA.
|
NR |
Medical procedure costs |
Spanknebel et al.2727 Spanknebel K, Chabot JA, DiGiorgi M, et al. Thyroidectomy using monitored local or conventional general anesthesia: an analysis of outpatient surgery, outcome and cost in 1,194 consecutive cases. World J Surg. 2006;30:813–24.
|
NR |
85 |
3,153 |
LA |
Lidocaine and bupicavaine |
217 |
2,760 |
Average total costs are significantly higher for GA than LA. Extensive procedures and increased operating room times impact significantly on costs. |
Thyroidectomy under LA results in similar outcome and morbidity rate to GA with reduced costs. |
Medical procedure costs |
Casati et al.2828 Casati A, Cappelleri G, Aldegheri G, et al. Total intravenous anesthesia, spinal anesthesia or combined sciatic-femoral nerve block for outpatient knee arthroscopy. Minerva Anestesiol. 2004;70:493–502.
|
Intravenous remifentanil 0.1–0.3 μg kg−1 min−1 and propofol 2–4 μg mL−1
|
40 |
317 |
sciatic-femoral nerve block SA |
sciatic-femoral nerve block: 25 mL 2% mepivacaine |
sciatic-femoral nerve block: 40 |
sciatic-femoral nerve block: 220 |
The use of sciatic-femoral nerve block results in the lowest total costs. Costs of drugs and disposable material required for anesthesia are lower in the SA group than the others. |
Regional anesthesia techniques reduce the rate of admission and the duration of stay in the PACU as compared with GA. |
Drugs, devices, staff |
SA: 8mg 0.5% bupicavaine |
SA: 40 |
SA: 308 |
The time readiness for home discharge are shorter in the GA group than regional anesthesia. |
Forssblad et al.2929 Forssblad M, Jacobson E, Weidenhielm L. Knee arthroscopy with different anesthesia methods: a comparison of efficacy and cost. Knee Surg Sports Traumatol Arthrosc. 2004;12:344–9.
|
Propofol and alfentanil |
88 |
236 |
LA |
LA: 30 mL 0.5% prilocaine with 4 μg mL−1 adrenaline |
LA: 181 |
LA: 76 |
The knee arthroscopy in LA is associated with lower cost than knee arthroscopy in SA and GA, because of the shorter recovery time of LA that reduces the need for recovery beds and postoperative care. |
Recovery time: 139.1 min (GA) vs 33.6 min (LA) vs 230.1 min (SA). |
Drugs, devices, staff |
SA |
SA: 60–90 mg 5% lidocaine with 5–10 mg ephedrine 25 mL 2% mepivacaine |
SA: 74 |
SA: 219 |
Time in hospital: 280.4 min (GA) vs 130.4 min (LA) vs 350.3 min (SA) |
Casati et al.3030 Casati A, Cappelleri G, Berti M, et al. Randomized comparison of remifentanil-propofol with a sciatic-femoral nerve block for out-patient knee arthroscopy. Eur J Anaesthesiol. 2002;19:109–14.
|
Intravenous remifentanil 0.1–0.3 μg kg−1 min−1 and propofol 2–4 μg mL−1
|
20 |
291 |
Sciatic-femoral nerve block |
20 |
288 |
Average total costs between GA group and sciatic-femoral block group in patients undergoing knee arthroscopy are not statistically significant. Costs related to the time spent in the PACU are statistically significant lower for the sciatic-femoral block group (USD 2.0) compared with the GA group (USD 55.7). |
Time in the hospital: 170 min (GA) vs 277 min (Sciatic-femoral block)
Length of stay in PACU: 23min (GA) vs 5 min
|
VAS pain: 7 (GA) vs 0
|
Disposable materials, drugs, staff |
Danelli et al.3131 Danelli G, Berti M, Casati A, et al. Spinal block or total intravenous anaesthesia with propofol and remifentanil for gynaecological outpatient procedures. Eur J Anaesthesiol. 2002;19:594–9.
|
Intravenous remifentanil 0.25 μg kg−1 min−1 and propofol 4 μg mL−1
|
20 |
260 |
SA |
10mg 0.5% bupivacaine |
20 |
282 |
No differences in average total costs between the two groups. |
Hospital discharge time: 156 min (GA) vs 296 min (SA)
|
Disposable materials, drugs, staff |
Pain control is similar. |
Lennox et al.3232 Lennox PH, Chilvers C, Vaghadia H. Selective spinal anesthesia versus desflurane anesthesia in short duration outpatient gynecological laparoscopy: a pharmacoeconomic comparison. Anesth Analg. 2002;94:565–8, table of contents.
|
Fentanyl 2 μg kg−1 and propofol 2 mg kg−1, 65% nitrous oxide |
10 |
127 |
SA |
3 mL 10 mg lidocaine and 10 μg sufentanil |
10 |
94 |
Average total cost of anesthesia and recovery is significantly less for patients in the SA group than the GA group.
Recovery costs are similar, whereas mean costs of anesthesia is significantly less in the SA group. Cost savings are due to lower cost of anesthetic supplies, sterilization, drugs.
|
Anesthesia time: 6.6 min (GA) vs 6.6 min (SA) PACU time: 112 min (GA) vs 101 min (SA) Postoperative pain: 50% (GA) vs 0% (SA)
Nausea/vomiting: 0% (GA) vs 30% (SA)
|
Supplies, drugs, staff |
Chan et al.3333 Chan VW, Peng PW, Kaszas Z, et al. A comparative study of general anesthesia, intravenous regional anesthesia, and axillary block for outpatient hand surgery: clinical outcome and cost analysis. Anesth Analg. 2001;93:1181–4.
|
Propofol, fentanyl, with isoflurane (up to 1.5%), 60% nitrous oxide |
39 |
718 |
Intravenous regional anesthesia |
Intravenous regional anesthesia: 35–45 mL 0.5% lidocaine |
Intravenous regional anesthesia: 45 |
Intravenous regional anesthesia: 513 |
The intra- and post-operative costs are the least in the intravenous regional anesthesia group than GA and axillary block, reflecting cost savings of approximately 30% in both cases. intravenous regional anesthesia is associated with short induction time, lower anesthetic drug and equipment costs in the operatory room, and with less demand on nursing time and lower drug and supply costs in the PACU. |
Total hospital stay time: 240 min (GA) vs 180 min (intravenous regional anesthesia) vs 244 min (axillary block) Anesthesia time: 83 min (GA) vs 72 min (intravenous regional anesthesia) vs 106 min (axillary block)
PACU recovery time: 70 min (GA) vs 45 min (intravenous regional anesthesia) vs 63 min (axillary block)
|
Disposable materials, drugs, staff |
Axillary block |
Axillary block: 40−50 mL 3% chloroprocaine and 2% or 1.5% lidocaine with 1:200,000 epinephrine |
Axillary block: 42 |
Axillary block: 755 |
Martikainen et al.3434 Martikainen M, Kangas-Saarela T Löppönen A, et al. Two percent lidocaine spinal anaesthesia compared with sevoflurane anaesthesia in ambulatory knee surgery - cost-effectiveness, home readiness and recovery profiles. Ambul Surg. 2001;9:77–81.
|
Intravenous propofol 2 mg kg−1 and alfentanil 1 mg with sevoflurane (up to 8%) |
30 |
333 |
SA |
3 mL 2% lidocaine |
30 |
293 |
Average total costs are significantly reduced for SA. However, GA is more cost-effective than SA in ambulatory knee surgery, if a short recovery unit time is required. |
Recovery unit time: 218min (GA) vs 224 min (SA)
Time to home-readiness: 96.4 min (GA) vs 140.8 min (SA) Post-operative pain low (VAS < 4 in 100% patients in SA vs in 86.7% in GA groups).
|
Disposable materials, drugs, staff |
Chilvers et al.3535 Chilvers CR, Goodwin A, Vaghadia H, et al. Selective spinal anesthesia for outpatient laparoscopy. V: pharmacoeconomic comparison vs general anesthesia. Can J Anaesth. 2001;48:279–83.
|
Propofol, fentanyl or sufentanil, and mivacurium or succinylcholine, with isoflurane nitrous oxide |
28 |
99 |
SA |
2–2.5 mL 1% lidocaine and 10–25 μg fentanyl |
24 |
107 |
Average total costs for anesthesia and recovery are similar between the two groups. Use of SA in alternative to GA does not reduce costs or improve efficacy of anesthesia and recovery for outpatient laparoscopy. |
Anesthesia time: 10 min (GA) vs 18 min (SA) PACU recovery time: 94 min (GA) vs 123 min (SA) Time to discharge: 124 min (GA) vs 150 min (SA) |
Disposable materials, drugs, staff |
Li et al.3636 Li S, Coloma M, White PF, et al. Comparison of the costs and recovery profiles of three anesthetic techniques for ambulatory anorectal surgery. Anesthesiology. 2000;93:1225–30.
|
Intravenous propofol 2.5 mg kg−1, fentanyl 1–2 μg kg−1 with 0.5–2% sevoflurane, 65% nitrous oxide |
31 |
289 |
SA |
SA: 30 mg lidocaine and 20 μg fentanyl
|
SA: 31 |
SA: 208 |
Average total costs are significantly decreased for LA than SA and GA because both intraoperative and recovery costs are the lowest.
Patients in the LA group are able to by-pass phase 1 recovery unit requiring less nursing labor (thus less costs). GA is associated to the highest costs.
|
Anesthesia time: 40 min (LA) vs 72 min (SA) vs 75 min (GA)
|
Drugs, supplies, staff |
LA with sedation |
LA: 31 |
LA: 138 |
Phase 1 stay: 0 (LA) vs 52 min (SA) vs 44 min (GA)
|
LA: topical 2% lidocaine gel and sedation-analgesia with propofol 75 μg kg−1 min−1 and 0.5 μg kg−1 fentanyl. 15 mL 2% lidocaine, 15 mL 0.5% bupicavaine, 0.5% epinephrine (1:200,000) |
Time to home-readiness: 76 min (LA) vs 193 min (SA) vs 171 min (GA)
|
Hospital stay: 116 min (LA) vs 266 min (SA) vs 247 min (GA) No differences in post-operative side effects or unanticipated hospitalizations. |
Song et al.3737 Song D, Greilich NB, White PF, et al. Recovery profiles and costs of anesthesia for outpatient unilateral inguinal herniorrhaphy. Anesth Analg. 2000;91:876–81.
|
Propofol 2.5 mg kg−1 min−1 1% sevoflurane, 65% nitrous oxide |
28 |
369 |
SA |
SA: 1.2-1.5 mL 0.75% bupicavaine and 25 μg fentanyl |
SA: 25 |
SA: 330 |
Average total costs are the lowest for the ilioinguinal-hypogastric nerve block group (reduced supplies during the intraoperative period, reduced labor during post-operative period). No difference between GA and SA. |
Anesthesia time: 109 min (ilioinguinal block) vs 119 (GA) vs 116 (SA) |
Drugs, staff, resources |
Ilioinguinal-hypogastric nerve block |
Ilioinguinal-hypogastric nerve block: 30 mL of 0.25% bupivacaine, 1% lidocaine and propofol 25-150 μg kg−1 min−1
|
Ilioinguinal-hypogastric nerve block: 28 |
Ilioinguinal-hypogastric nerve block: 288 |
Ilioinguinal-hypogastric nerve block is the most cost-effective techniques for outpatients undergoing unilateral herniorrhaphy with respect to recovery, patient comfort, and associated incremental costs. |
Phase 1 PACU: 5 min (ilioinguinal block) vs 40 (GA) vs 35 (SA)
Phase 2 unit: 153 min (ilioinguinal block) vs 168 (GA) vs 276 (SA)
Time to home-readiness: 133 min (ilioinguinal block) vs 171 (GA) vs 280 (SA)
Time to actual discharge: 158 min (ilioinguinal block) vs 208 (GA) vs 309 (SA)
Maximum pain VAS: 15 (ilioinguinal block) vs 39 (GA) vs (34) SA
Maximum nausea VAS: 1 (ilioinguinal block) vs 27 (GA) vs 4 (SA)
|