Two anesthesias for one surgery, is that excessive charging?

Aunt Zhang was recently hospitalized. After examination and diagnosis, the doctor confirmed that she had "uterine fibroids". According to Aunt Zhang's condition, age and other factors, the doctor decided to perform "laparoscopic hysterectomy" on her, which is a minimally invasive surgery. Everything went smoothly from admission, examination to surgery. She didn't know anything about the whole operation. It was like she had a good sleep and even had a dream. After the operation, the anesthesiologist installed a pain pump for her, and she didn't feel any pain at all.

But the day after the operation, when the daily list was handed down, Aunt Zhang was confused. She saw the following charges: general anesthesia, quantity 1, nerve block anesthesia quantity 0.3. How could there be two anesthesia for one operation? There was only one anesthesia, I just took a nap. Besides, if I already had general anesthesia, why do I need other anesthesia? And why is nerve block anesthesia 0.3? Can anesthesia be only 0.3? Is it a random charge? Aunt Zhang was wondering.

Just then, the nurse in charge of the patient came to inspect the ward, and Aunt Zhang hurriedly asked her what was going on. The nurse looked at it and shook her head, saying that she didn't understand either, and asked her to ask her attending physician. Aunt Zhang went to ask the attending physician, who looked at it and said that he didn't understand either, and that she had to ask her anesthesiologist.

So the attending doctor helped her call the anesthesiologist, who came in a short while later and gave her a comprehensive and detailed explanation.

It turns out that although this laparoscopic hysterectomy is a minimally invasive surgery, the anesthesia is not "minor anesthesia"! Because during the entire operation, carbon dioxide gas needs to be continuously filled into the patient's abdominal cavity to maintain a certain pressure so that a space is formed inside the abdominal cavity. With the help of lighting equipment and video transmission equipment, the image inside the abdominal cavity can be clearly transmitted to a dedicated video screen. In this way, the surgeon can clearly see the specific location and condition of the lesion and perform the operation. However, this has a great impact on the patient's own physiology and internal environment. For example: the stretching of the peritoneum by the abdominal bulge, the compression of the diaphragm, abdominal organs, and blood vessels by carbon dioxide, and the absorption of carbon dioxide, etc., may lead to a decrease in the amount of blood returning to the heart, obstruction of cardiac output, circulatory fluctuations, dyspnea, hypercapnia, etc., which awake patients cannot tolerate at all. This requires general anesthesia.

However, any type of anesthesia has its advantages and disadvantages, indications, and contraindications. Nerve block anesthesia or spinal anesthesia, which is commonly referred to as "semi-anesthesia", has disadvantages such as incomplete blockade, fear and anxiety that may occur when the patient is awake during the operation, and the inability of special patients to cooperate, and cannot meet the needs of all types of surgeries. However, the circulation is relatively stable and the postoperative analgesia effect is good. General anesthesia can meet the needs of all types of surgeries, and endotracheal intubation can also ensure good respiratory management, but the use of large amounts of sedatives, analgesics, and muscle relaxants may lead to adverse reactions such as postoperative nausea, vomiting, respiratory depression, and delayed awakening. Therefore, combined anesthesia came into being.

Combined anesthesia is the simultaneous use of two or more anesthesia methods, such as general anesthesia and nerve block anesthesia, for surgery or treatment, using the advantages of each method to achieve a complementary effect of adding advantages and offsetting disadvantages. The advantages of combined anesthesia are mainly that it can meet the depth of anesthesia required for various surgeries, greatly reducing the dosage of general anesthetics and the use of opioids. At the same time, nerve block anesthesia is also beneficial for postoperative analgesia, avoiding restlessness and pain during the general anesthesia recovery period, and promoting patient recovery.

During Aunt Zhang's operation, the anesthesiologist performed an ultrasound-guided transverse abdominal fascia block (TAP) on her abdomen after general anesthesia. This not only greatly reduced the amount of general anesthesia drugs used, ensured early postoperative awakening, and reduced the incidence of postoperative nausea, vomiting, and agitation, but also facilitated postoperative analgesia, early bed restlessness, and promoted recovery.

According to the "Henan Province Medical Institution Service Fee Standards", if two anesthesia methods are used at the same time, the second anesthesia method can only be charged 0.3 of the standard fee. Therefore, there will be a charge item of "nerve block anesthesia, quantity 0.3" on Aunt Zhang's daily list.

After hearing what the anesthesiologist said, Aunt Zhang understood it all at once! Thinking about it again, having an operation was just like sleeping, and she didn't feel any pain after the operation. Aunt Zhang gave a thumbs up and praised the anesthesiologist: "The anesthesia is really good!"

About the author: Wang Wenjiang, deputy director of the Department of Anesthesiology, Yichuan County People's Hospital. Graduated from Xinxiang Medical College with a bachelor's degree in anesthesia, has been engaged in clinical anesthesia for 15 years. He studied anesthesia for one year at Zhongshan Hospital Affiliated to Fudan University and loves anesthesia. He is interested in poetry and writing.