Management of incomplete regional anaesthesia in Germany: results of a nation-wide survey

Abstract

Regional anaesthesia (RA) provides well-defined benefits with known attendant risks. However, incomplete blockade may introduce unanticipated risks depending on the compensatory measures employed. Until now, no data were available characterizing the pattern of response of German anaesthesiologists in this situation. This study analyses interventions in response to incomplete RA in a nation-wide setting. A questionnaire was sent to every German anaesthesia department (n= 1381). Questions focused on interventions coping with an incomplete RA and differentiated between a pre- and a peri-surgical setting and measures to face pain outside the surgical field. If systemic supplementation was administered, we analysed the substances and characterized their influence on subsequent patient care. Six hundred and sixty-seven questionnaires were returned anonymously, representing a return rate of 48.3%. If RA was incomplete before surgery, 56.8% of anaesthesiologists repeated peripheral blocks, 48.5% repeated epidural (EDA) and 60.4% repeated spinal anaesthesia (SPA). 56.9% of clinicians preferred an early switch to general anesthesia (GA). If RA was incomplete during surgery, 49.5% tended to switch early to GA, 13.9% made attempts to avoid this by intensive systemic supplementation. Benzodiazepines and opioids were the most commonly used substances. Pain or discomfort outside the surgical field was widely managed by intravenous supplementation (67.7%) and only 10.6% were willing to switch to general anaesthesia. In Germany, anaesthesiologists manage incomplete RA using a widespread spectrum of measures. Some might introduce specific risks, which potentially outweigh the benefits of RA in comparison to GA techniques.