A Block Room in Parallel Processing Shortens the Anesthesia Utilization Time in Orthopedic Operating Rooms; A Prospective Cross-Sectional Study
Suwimon Tangwiwat MD*, Arissara Iamaroon MD*, Angkana Lurngnateetape MD*, Keerati Chareancholvanich MD**, Chutatip Nuntawinit BNS***, Pawinee Imkong MD*
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Division of Nursing Siriraj Hospital, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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.
Keywords : Parallel system, Regional anesthesia block room, Anesthesia utilization time, Operating room turnover time
