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To stay or not to stay: Evaluating the effect of Bupivacaine in spinal anaesthesia on unplanned admissions in Day Surgery

James Bailey, Ewe Teh
Lister Hospital, Stevenage, United Kingdom


Introduction: Spinal anaesthesia with short-acting agents has several advantages in the day surgery setting. However, continued use of long-acting agents, such as Bupivacaine, might be limiting the use of spinal anaesthesia due to their side effect profile. This audit aimed to determine if using long-acting intrathecal agents resulted in more unplanned admissions than the British Association of Day Surgery's target of <2%.

Methods: We conducted a retrospective analysis of every patient who received spinal anaesthesia at Lister Hospital between April and November 2022, where the only available intrathecal agent was Bupivacaine. We reviewed patient records to identify unplanned hospital admissions following day surgery and investigated whether they were caused by side-effects of spinal anaesthesia, namely urinary retention or inability to mobilise

Results: During the review period, 518 patients received a spinal anaesthetic, out of which 97 (18.7%) were planned day cases. Of the 97 patients, 14 (14.4%) had unplanned admissions, of which 5 (5.2%) were due to purely anaesthesia-related causes, which exceeds the target. All five were admitted for urinary retention. The median time for administering spinal anaesthesia was 11:23 am.

Conclusions: Patients are being admitted after day case procedures due to complications from their long-acting spinal anaesthetic. We are also avoiding giving spinal anaesthetics later in the day. Shorter acting intrathecal anaesthetic agents may be a superior alternative to Bupivicaine in the day surgery setting. After presenting these findings in our departmental governance meeting, we decided to apply to add intrathecal Prilocaine to our local formulary.