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.
Highlights
Suitable equipment and technique are keys in providing safe and effective regional anesthesia
We hypothesized that a nationwide survey would shed light on current practice in nerve localization, safety, and technical approaches used for peripheral nerve blocks (PNB)
To uncover anesthesiologists’ current behavior and technical approaches we asked all members of the Swiss Society for Anaesthesiology and Resuscitation (SSAR/SGAR) to participate in a nationwide survey
Summary
Suitable equipment and technique are keys in providing safe and effective regional anesthesia. While the implementation of ultrasound has significantly increased both safety and effectiveness, successful administration of regional anesthesia depends on additional factors such as physicians’ training, patient and block selection[1]. Despite sophisticated simulation opportunities, numerous publications, and extensive discussion, little is known about anesthetists’ current clinical practice and the technical approaches they use to localize peripheral nerves for regional anesthesia. We aimed to study the clinical practices and technical approaches currently used by anesthesiologists to provide regional anesthesia. We hypothesized that a nationwide survey would shed light on current practice in nerve localization, safety, and technical approaches used for PNB. We considered whether the choice of equipment and procedures (such as nerve stimulation and ultrasound, sterile preparations, periprocedural analgesia, sedation, and clinical approaches) depends on factors such as the anesthetist’s experience and expertise, the hospital setting, and the country’s language region
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