spinal's in out patient surgery?

[brownbook]

For five years I worked out patient surgery. It was part of an acute care hospital, not a free standing out patient surgery clinic. We admitted and recovered both "in" patients to be admitted to the hospital, and "out" patients going home the same day

We did a garden variety of surgeries and it was not uncommon to do spinal anesthesia. Some for orthopedic procedures and some for whatever other cases where the surgeon or anesthesiologists decided spinal was a better way to go.

I know we weren't thrilled when in the early afternoon we realized an "out" patient spinal was coming to PACU. But I honestly only remember one case that took about 6 hours for the spinal to wear off. Most wore off sooner. But I admit my memory isn't perfect!

I moved and currently work in a free standing out patient surgery clinic. When anesthesia even hints that they might want to do a spinal my co-workers look askance and say "we can't, don't, do spinals, it takes 8 hours, or too long, for them to wear off." This isn't a "policy" just the nurses preference.

What has been your experiences? Do other out patient surgery facilities do, allow, spinals?

[GHGoonette, BSN, RN]

I love to see our manager's face if we kept our spinal cases for 8 hours in PACU With 4 bays serving 4 theaters, it would cause some serious logjams....

If it's your hospital's policy to keep your spinals until motor and sensory functions are fully restored, it casts your ward staff in a pretty poor light. Are they not considered capable of monitoring patients post-spinal? Most of our caesars are done under spinal, and we just ensure that their vitals are stable, that they understand the working of the PCA device, that they're nicely cleaned up and comfortable and that there's no abnormal levels of bleeding. The ward staff do the rest.

I don't think I'd be very impressed with any doctor, whether surgeon or anaesthetist, who countenanced spinal anaesthetic on day-surgery patients. If the patient's health is such that general is not a safe option, they should not be discharged the same day anyway, but kept at least overnight for observation. Even with epidural anaesthetic, we do not keep the patients for hours either, unless they have a genuine surgery or anaesthetic-related problem. Sometimes transfer to ICU is delayed due to a bed shortage, but as I already mentioned, we have very restricted space and it is not logistically possible to keep our patients indefinitely. It's standard procedure for all patients with continuous epidural infusion to go to ICU, and they have to make space for such patients, as they know we don't have room for them.