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Howe D, Hulgur M. A survey about the practice of regional anesthesia in Manchester and Lancashire. Pain Pract 2024; 24:404-408. [PMID: 37864326 DOI: 10.1111/papr.13311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
INTRODUCTION In 2021, the UK Royal College of Anaesthetists published an updated curriculum which outlines specific peripheral nerve blocks in which all anesthetists must achieve competency during their training. Little is known about which nerve blocks anesthetists in the UK can perform, nor which techniques they use to perform them. METHODS We conducted a survey of anesthetists in North West England to discover their experience in anesthesia, which nerve blocks they can perform, and which techniques they use to perform them. RESULTS Overall, 195 responses were received. Seventy-nine respondents (44%) preferred to perform nerve blocks on anesthetized patients, 70 (40%) preferred to perform nerve blocks with the patient awake with no sedation. One hundred and thirty-seven (85%) respondents used ultrasound only to localize nerves when performing a block. Among consultant respondents, 21 (19%) were unable to perform any upper limb block, and 48 (44%) were unable to perform any block of the thorax, both are a required competency of trainees under the 2021 curriculum. DISCUSSION Trainees may struggle to achieve the required competencies of the new curriculum given many consultants are also unable to perform them. A structured placement in regional anesthetic training in each stage of training could help improve the acquisition of skills and knowledge among trainees. Further studies are needed to assess the ability of anesthetists nationwide in regional anesthesia.
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Affiliation(s)
- David Howe
- Department of Anesthesia, Stepping Hill Hospital, Manchester, UK
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A Survey of Regional Anesthesia Use in Greece and the Impact of a Structured Regional Anesthesia Course on Regional Techniques Knowledge and Practice. J Clin Med 2021; 10:jcm10214814. [PMID: 34768333 PMCID: PMC8584817 DOI: 10.3390/jcm10214814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Due to the growing interest in regional anesthesia (RA) techniques and the realization of the need for formalized education in them, the Greek Chapter of the European Society of Regional Anesthesia and Pain Therapy (ESRA-Hellas) has established a structured hands-on training course held annually since 2009, which is quite popular in the community of Greek anesthesiologists. The aim of the current survey was twofold: first, to provide an overview of the current practice of RA in Greece; secondly, to evaluate the effect the aforementioned training course has on participants’ knowledge and attitude towards RA. Methods: An electronic questionnaire was uploaded on SurveyMonkey and a link giving access to the questionnaire was forwarded via email to a mailing list of 825 practicing Greek anesthesiologists held in the electronic database of ESRA Hellas. The survey was totally anonymous and no identifying information was collected throughout. It contained questions relating to the anesthesiologists’ demographic characteristics, their RA practice, and information pertaining to the RA training course. Results: A total of 424 fully completed questionnaires were received, representing an overall response rate of 51.4%. Attendants of the course are more familiar than non-attendants with the performance of peripheral nerve blocks with neurostimulation and/or ultrasound guidance (p < 0.001). Attendants are also less likely to practice exclusively general anesthesia, more likely to use peripheral blocks for lower limb surgery, and more likely to consider taking the European Diploma of RA in comparison to non-attendants (p < 0.001, p = 0.018 and p = 0.002, respectively). Both cohorts consider the course of value and agree that the main reason to use regional techniques is to ensure optimal postoperative analgesia, while the main hindrance to RA practice is the lack of relevant education in the techniques, especially those under ultrasound guidance. Regarding improvement of the course, most participants suggested devoting ampler time in hands-on ultrasound practice and application. Conclusions: Greek anesthesiologists seek educational activities in the field of RA and the course seems to fulfil the majority of attendants’ expectations. There will be further effort by the organizers to improve weaknesses of the current course and undertake further educational initiatives in the field of RA according to international recommendations.
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Goffin P, Lecoq J, Sermeus L. The practice of regional anesthesia in Belgium – a national survey. ACTA ANAESTHESIOLOGICA BELGICA 2021. [DOI: 10.56126/72.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background : National surveys are useful to assess the state of regional anaesthesia (RA) practice in a particular country. Given that such information was lacking in Belgium, we conducted a survey to evaluate the Belgian practice of peripheral nerve blocks (PNBs) with a particular focus on its safety aspects.
Methods : A survey was sent by email to 1510 Belgian anesthesiologists. No identifying information was collected. Data were collected between September 2019 and October 2019.
Results : We collected 324 questionnaires (response rate 21%). Eighty five percent of respondents perform regularly PNB. 99% place a venous access before performing a block, and more than 90% monitor patients with minimum peripheral pulse oximetry.
The majority monitor patients for a minimum of 30 minutes after the injection of local anesthetic (LA). Ultrasound-guided technique for RA is used by 89% of respondents. Neurostimulation is totally abandoned by 20% of them. Monitoring of injection pressures is performed by 21% of respondents. More than 50% of respondents use sterile gloves, surgical drapes and a mask. With regards to the solution of LA used, 52% of respondents never mix LAs. An adjuvant is always used by 15% of the respondents while 10% of them never use them.
Conclusions : This survey suggests that the practice of PNBs in Belgium is in line with the current international guidelines. This survey can serve as a benchmark for future evaluation and comparison between RA techniques. These observations should be taken into account for the implementation of national guidelines and therefore for the improvement of safety in the practice of PNBs.
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Singh N, Ponde V, Jagannathan B, Rao PB, Dixit A, Agarwal G. Development and validation of a Questionnaire to study practices and diversities in Plexus and Peripheral nerve blocks. Indian J Anaesth 2021; 65:197-201. [PMID: 33776109 PMCID: PMC7989482 DOI: 10.4103/ija.ija_1161_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/27/2020] [Accepted: 02/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background and Aims Regional anaesthesia techniques are a part of perioperative medicine that affects both perioperative and long-term outcomes. We have a paucity of the data on the usage and practices of plexus and peripheral nerve blocks (PNBs). To the best of our knowledge, this is the first effort to validate a survey for plexus and PNBs. Subsequently, this questionnaire could be used for the survey to look for the trends and disparities in PNB practices and further to develop a national registry in the future. Methods Thirty questions were prepared after evidence-based search and reviewed by experts for suggestions. Changes were done and the questionnaire with the grading sheet was sent to 19 experts. The responses were analysed to calculate the content validity index (CVI) item-wise (I-CVI), scale-wise (S-CVI), and modified kappa statistics. The I-CVI of 0.78 and an S-CVI/average of 0.90 was taken as acceptable with more than six experts. Results Fourteen experts out of 19 assessed and graded the questions as per the provided sheet and submitted suggestions through the mail. Question reframing, option reconsideration, and change from single to multiple choices were incorporated as per the suggestions of the experts. Mean I-CVI for relevance, simplicity, clarity, and ambiguity was 0.99, 0.98, 0.98, and 0.99, respectively. S-CVI/average was 0.98, 0.97, 0.98, and 0.99 for relevance, simplicity, clarity, and ambiguity, respectively. Conclusion We conclude that this questionnaire has met the content validity criteria and can be used to study plexus and PNBs practices.
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Affiliation(s)
- Neha Singh
- Department of Anaesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | - Vrushali Ponde
- Department of Anaesthesia, Surya Children Hospital, Mumbai, Maharashtra, India
| | | | - Parnandi B Rao
- Department of Anaesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | - Amit Dixit
- Department of Anaesthesia, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Gaurav Agarwal
- Department of Anaesthesia, Care Hospital, Bhubaneswar, Odisha, India
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Malhotra N, Ramachandran S, Velayudhan S, Singh Bajwa S, Joshi M, Mehdiratta L, Hiremath V. Regional anaesthesia practices in India: A nationwide survey. Indian J Anaesth 2021; 65:853-861. [PMID: 35221356 PMCID: PMC8820327 DOI: 10.4103/ija.ija_803_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/03/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022] Open
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Yang Q, Xie K, Xiong L. Anaesthesiology in China: present and future. Br J Anaesth 2019; 123:559-564. [PMID: 31543268 DOI: 10.1016/j.bja.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 07/12/2019] [Accepted: 08/06/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Qianzi Yang
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Keliang Xie
- Department of Anaesthesiology, Tianjin Institute of Anaesthesiology, General Hospital of Tianjin Medical University, Tianjin, China
| | - Lize Xiong
- Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China; Department of Anaesthesiology and Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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Luedi MM, Upadek V, Vogt AP, Steinfeldt T, Eichenberger U, Sauter AR. A Swiss nationwide survey shows that dual guidance is the preferred approach for peripheral nerve blocks. Sci Rep 2019; 9:9178. [PMID: 31235760 PMCID: PMC6591381 DOI: 10.1038/s41598-019-45700-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 06/12/2019] [Indexed: 11/09/2022] Open
Abstract
Ultrasound has significantly increased safety and effectiveness in regional anesthesia. However, little is known about its clinical use. We studied clinical approaches currently used by anesthesiologists, conducted a nationwide survey, and analyzed data collected in ordered logistic regression models. All active members of the Swiss Society for Anaesthesiology and Resuscitation (SSAR/SGAR) were asked to participate. Reported practice in nerve localization, safety, and techniques used for peripheral nerve blocks (PNB) were main outcome measures. Experience ranged from 3 to >30 years. The mean number of block techniques mastered was 11.5 ± 5.9. Standard monitoring was regularly used, whereas sterile coats were less frequently used by anesthesiologists who self-estimated a higher level of expertise in PNB (ordered logit coefficient −0.05, 95% CI −0.07 to −0.02, P < 0.001; pseudo r2 = 0.019; probability > Chi2 = 0.02). The more self-estimated expertise anesthesiologists had, the less likely they were to use nerve stimulation in combination with ultrasound (dual guidance) (ordered logit coefficient −0.31; 95% CI −0.85 to −0.03: P = 0.03; pseudo r2 = 0.007; probability > Chi2 = 0.05). The high share of reported standard monitoring meets the recommendations of the Helsinki Patient Safety Declaration. Dual guidance appears to be the preferred approach for safely localizing nerves for PNB in Switzerland.
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Affiliation(s)
- Markus M Luedi
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Vanessa Upadek
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas P Vogt
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thorsten Steinfeldt
- Department of Anaesthesiology, Diakonie-Klinikum Schwäbisch Hall, Schwäbisch Hall, Germany
| | - Urs Eichenberger
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Axel R Sauter
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. .,Division of Emergencies and Critical Care, Department of Anaesthesiology and Department of Research and Development, Oslo University Hospital, Oslo, Norway.
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Huang J, Hoang P, Simmons WR, Zhang J. Free Emergency Manual Books Improve Actual Clinical Use During Crisis in China. Cureus 2019; 11:e4821. [PMID: 31403011 PMCID: PMC6682387 DOI: 10.7759/cureus.4821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Emergency manuals (EM) are widely implemented and effective tools for anesthesiologists and perioperative teams to manage patients during critical events. Team simulation studies have shown that the use of training aids and checklists decreases human error. Previous research has examined the use of EM at hospitals in the United States, but few studies have explored its impact in an international setting. In this paper, we conduct a nationwide survey in China to assess the implementation and effectiveness of EM in clinical settings. Methods Based on the known benefits of using these training aids, we hypothesize that introducing EM will improve team response and reduce errors during crisis management. Copies of the translated Stanford University Operating Room Emergency Handbook were distributed free of charge to hospital anesthesiology departments across China. A survey was then sent out to members of the New Youth Anesthesia Forum, a social networking group of over 100,000 anesthesiologists. Results Respondents (n = 818) were separated based on whether or not they received the free EM (yes = 410; no = 408). Our study found that groups who received the manuals demonstrated significantly higher levels of self-review, group study, simulation training participation, and usage during critical events than groups that did not receive the free books (respectively; p < 0.001). Conclusions These findings strengthen prior evidence suggesting that implementing EM can contribute to the effective management of acute events in a hospital and preoperative setting. Overall, EM can minimize preventable patient risk and benefit anesthesiologists in their clinical practice. These findings indicate that free books can enhance the implementation of emergency manual and actual emergency manual use during critical events.
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Affiliation(s)
- Jeffrey Huang
- Anesthesiology, University of Central Florida College of Medicine, Orlando, USA
| | - Peter Hoang
- Anesthesiology, University of Central Florida College of Medicine, Orlando, USA
| | - Wayne R Simmons
- Anesthesiology, Hospital Corporation of America West Florida Graduate Medical Education Consortium / Oak Hill Hospital, Brooksville, USA
| | - Jianfeng Zhang
- Anesthesiology, Xiangyang Central Hospital, Xiangyang, CHN
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Lu J, Cheng W, Huang J. Report on Cardiac Anesthesia Progress and Challenges in China. J Cardiothorac Vasc Anesth 2018; 32:2365-2371. [DOI: 10.1053/j.jvca.2017.12.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Indexed: 11/11/2022]
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Whitten I, De Oliveira GS. Selection of anesthesia technique: Not always the right reasons or the right outcomes…. J Clin Anesth 2017; 42:49-50. [PMID: 28810206 DOI: 10.1016/j.jclinane.2017.08.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 08/05/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ira Whitten
- Rhode Island Hospital, Brown University, Providence, USA
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