The role of peripheral nerve block analgesia in advancing therapeutic effectiveness spanning the episode of care

Health care reform has brought an unprecedented emphasis on attaining greater value for patients from treatment managed by individual providers and health care facilities. The value is defined as the relationship of the outcome achieved over an episode of care compared to the effort and resources employed to achieve this outcome. It is delivered when patients recover faster with fewer expensive resources, such as hospital, skilled nursing, or rehab facility stays. It is assessed by considering longer episodes of care, such as 30-180 days after performance of a procedure; and by assessing functional recovery, independence, and reintegration as a productive member of society. We review the evidence that suggests that peripheral nerve analgesia may favorably influence the value relationships described. Where insufficient or no evidence exists, we point out the need for further improvements in the pipeline of evidence for evidence-based medicine.