Local Anesthesia Research Articles

Racial and Ethnic Disparities in Regional Anesthesia: A Brief Review.

Disparities in regional anesthesia may limit patients' access to appropriate care. We reviewed literature from 2013 to 2023 regarding health disparities in regional anesthesia. While there were some exceptions, patients belonging to racial/ethnic minority groups and those with lower socioeconomic status did not receive regional anesthesia as frequently as their White or higher-income peers. As regional anesthesia continues to emerge as a preferred method of managing chronic pain conditions and providing surgical anesthesia, it is essential to ensure that it is provided equitably across the patient population.

Prostatic stents: a systematic review and analysis of functional outcomes and complication rate.

This review aims to identify and summarize the current literature on the use of prostatic stents or nitinol devices as minimally invasive techniques for the management of lower urinary tract symptoms (LUTS) resulting from benign prostatic hyperplasia (BPH). A comprehensive search of the literature was conducted until October 2023. Only original articles written in English were considered for inclusion. This review has been registered in PROSPERO (registration number CRD42023474884). Thirty-eight articles were included (2618 patients). Generally, the risk of bias was deemed as high or very high. The most frequently investigated stents were the UroLume, followed by the Memokath/Memotherm. The mean age was 72.01 ± 5.6 years, with a mean prostate volume of 48.27 ± 12.8 cc and a mean urethral length of 40.53 ± 9.16 mm. Surgeries were usually performed under local anesthesia. The rates of catheter-free status and complications were 85.2% and 30.83%, respectively. The primary complications included urinary tract infections (17.2%), followed by calcifications (12.6%), irritative symptoms (12.2%), and acute urinary retention (10.4%). During a follow-up period of 12 months, the failure rate intended as stent removal or repositioning was 14.8%. The International Prostate Symptom Score (IPSS) showed an overall improvement of 9.85 points. The mean improvement in maximum flow rate and post-void residual volume were 6.62 ml/sec and 147 ml, respectively. Prostatic stents remain an efficient choice for addressing obstructive symptoms from BPH, offering the advantage of being performed under local anaesthesia, relieving symptoms with good functional outcomes and a low incidence of major complications. Prospective studies are needed to corroborate these results.

Prospective Assessment of Safety, Tolerance, and Perceptions of Awake Airway and Esophageal Dilation.

An increasing number of laryngeal and esophageal procedures are being performed as "awake" procedures (non-general anesthesia), with some under local anesthesia, including in clinic. While high tolerance and safety profiles have been reported for various laryngeal procedures, few studies directly assess tolerability of awake dilation procedures of the upper esophagus (UE) and laryngotracheal airway (LTA). Prospective, open-label. Prospectively collected patient and physician surveys from a tertiary laryngology center recorded patient tolerance, safety, and perceptions of awake UE and LTA balloon dilation. Fifty-six awake procedures were performed on 41 patients, including 46 UE and 20 LTA dilations. All procedures were successfully completed. Overall pain was mild (3.5 ± 2.4/10, ranging 0 = no pain to10 = worst pain) and the dilation itself was reportedly the most painful portion (4.1 ± 2.9/10). Patient satisfaction with the procedure was high (7.0 ± 2.2/10, ranging 0 = worst to 10 = best experience). Most patients would undergo the procedure again (73.6%) and would recommend the procedure to others (89.3%). Patient-reported tolerance was similar immediately postoperatively and at follow-up. LTA and UE dilation patients reported similar levels of tolerance. Awake upper esophageal balloon dilation is a safe, well-tolerated procedure with high completion and patient satisfaction rates. Similarly, early experience with awake laryngotracheal airway balloon dilation suggests comparable favorability, although careful consideration of patient selection and procedural implementation is strongly recommended to optimize and protect patient safety. 3 Laryngoscope, 2024.

Back to the Future: Historic Insights and Recent Innovations in Pediatric Regional Anesthesia

Pediatric regional anesthesia is evolving with new peripheral nerve blocks and techniques aimed at improving perioperative pain management. While caudal blocks have long been standard due to their simplicity and low complication rates, newer fascial plane blocks offer comparable efficacy with enhanced nerve coverage tailored to specific surgeries. Moreover, adjuncts like dexmedetomidine and dexamethasone have shown promise in prolonging block duration and enhancing post-operative pain relief and patient satisfaction. The integration of these advancements into clinical practice has yielded significant benefits, including reduced intraoperative fluid requirements, decreased reliance on opioids postoperatively, earlier initiation of enteral nutrition, lower readmission rates, shorter hospital stays, and decreased overall hospital costs. Our review underscores the technical progress and expanding literature supporting the rapid adoption of these impactful regional anesthesia techniques in pediatric care.

Effective blind bilateral superficial cervical plexus block for tracheostomy tube insertion in a geriatric patient with Ludwig angina with hypertension in resource constrained area: a case report

IntroductionLudwig angina is a rare, rapidly spreading submaxillary, submandibular, and sublingual necrotizing life-threatening widespread cellulitis of the soft tissue on the floor of the mouth that can cause fatal complications because of airway obstruction. Currently, there are few published studies assessing the efficacy of superficial cervical plexus block for airway surgery and there is no agreement in the literature about airway management. The published recommendations differ and are based on the authors’ own experiences and available resources. This report aimed to provide insight into critical patient management by performing regional anesthesia with fewer complications to the cardiovascular and respiratory systems.Case presentationWe report the case of a 70 year-old hypertensive Black Ethiopian woman with American Society of Anesthesiologist–Physical Status class III and hypertension, who was admitted to the hospital for treatment by her surgeon. The surgeon diagnosed her with Ludwig angina. After adequate physical examination and laboratory investigation, she arrived at the operation room for exploration and drainage of the abscess with a superficial cervical plexus block. She arrived safely at the adult intensive care unit for frequent suctioning. The block was effective until 6 h after the procedure with visual analogue scale (2/10), her vital signs remained stable throughout the postoperative period, and then the tracheostomy tube was removed by the surgeon after 10 days. The patient’s hemodynamic status and breathing effort were satisfactory, and she was discharged 15 days later.Clinical discussionProper airway management is critical for the survival of patients diagnosed with Ludwig angina. According to recent studies, an increasing number of patients with Ludwig angina require intensive care unit admission for tracheal intubation and mechanical breathing. However, it is uncertain whether intensive care reduces the death rate in patients with Ludwig angina. Finally, it is suggested that studies with large sample sizes and strong levels of evidence be conducted to conclude the effectiveness of superficial cervical plexus block for airway emergency surgeries.ConclusionManagement of the airway in patients with Ludwig angina is challenging. Clinicians must take precautions and make sharp decisions on the basis of a variety of circumstances, including the availability of equipment at medical facilities, such as fiberoptic intubation equipment; the anesthetist’s level of experience, such as performing superficial regional block and good mask ventilation; and the patient’s medical status at the time of presentation. As a result, intervention needs to be quick so as to avoid airway obstruction and further complications.

Utilization of Enhanced Recovery After Surgery (ERAS) protocol in pediatric laparoscopic sleeve gastrectomy: a quality improvement project.

The obesity epidemic has led to an increased number of adolescents requiring metabolic and bariatric surgery (MBS), but there is paucity of data on the impact of implementing all aspects of Enhanced Recovery After Surgery (ERAS) protocols to improve outcomes in this population. We implemented a comprehensive ERAS pathway for adolescents undergoing laparoscopic sleeve gastrectomy (LSG). Key elements included pre-operative fasting with carbohydrate loading in the morning of surgery, comprehensive anti-emetic and analgesic regimens including intra-operative lidocaine infusion (initiated before formal ERAS launch), regional anesthesia, and early goal-directed ambulation. We tracked opioidutilization, rescue anti-emetic use, time to oral intake,and hospital length of stay (HLOS) as outcome measures, and post-operative pain and returns to the system as balancing measures. Eighty-six patients(52 patients pre-ERAS and 34 patients post-ERAS) underwent LSGwith no differences in demographics. The post-ERAS group had earlier time to oral intake (3.0 vs. 5.5 h, p = 0.003), used less rescue anti-emetics, (8.0vs.16.0 mg, p < 0.001), and had shorter HLOS (33 vs. 54 h, p < 0.001) but no difference in opioid use (0.370 vs. 0.435 MME/kg, p = 0.17), post-operative pain scores or return to the system. Our novel use of bariatric-specific ERAS protocol with intra-operative lidocaine infusion accelerates the time to goal-directed oral intake and decreases HLOS without increasing the rate of returns to the system. This study highlights the feasibility and effectiveness of adapting adult ERAS protocols to the pediatric MBS population. Level III.

A COMPARISON OF 0.5% BUPIVACAINE ALONE VERSUS 0.5% BUPIVACAINE WITH VERAPAMIL AS AN ADJUNCT IN ULTRASOUND-GUIDED SUPRACLAVICULAR BRACHIAL PLEXUS BLOCK

Objective: Supraclavicular brachial plexus blocks are commonly performed for surgeries on the upper limb because they are highly effective for both anesthesia during the procedure and pain control afterward. This method targets the entire brachial plexus, making it a popular alternative to general anesthesia, as it minimizes associated risks while offering better pain relief after the surgery. Bupivacaine, a long-lasting local anesthetic, is often preferred for this block, though its pain-relieving effects eventually wear off. Owing to limitations regarding the duration of analgesia, many adjuncts have been tried since time immemorial to enhance the effectiveness of the blocking properties of these local anesthetics. Verapamil, a calcium channel blocker, has emerged as a promising adjunct that can potentially enhance and prolong the effects of Bupivacaine. This study aims to compare the efficacy of 0.5% Bupivacaine alone versus Bupivacaine combined with Verapamil in ultrasound-guided supraclavicular brachial plexus blocks. Methods: A randomized clinical trial was conducted on patients undergoing elective upper limb surgeries under ultrasound-guided supraclavicular brachial plexus block. Group A received 30 mL of 0.5% Bupivacaine, whereas Group B received 30 mL of 0.5% Bupivacaine with 5 mg of Verapamil. Primary outcomes included the time of onset of sensory and motor blockade and the duration of analgesia for the same, whereas secondary outcomes included post-operative pain scores and hemodynamic stability. Results: The addition of Verapamil to Bupivacaine significantly accelerated the onset of sensory and motor blockade in Group B compared to Group A. Group B also exhibited a significantly prolonged duration of both sensory and motor blockade and reduced post-operative analgesic requirements. Conclusion: Verapamil helps boost the effectiveness of Bupivacaine in supraclavicular brachial plexus blocks, speeding up the onset of its actions and extending its pain-relieving effects. This makes it a useful addition to local anesthetics, making it a valuable adjunct in regional anesthesia.

Effectiveness of phentolamine mesylate, vibration and photobiomodulation in reducing pain and the reversal of local anesthesia: A systematic review.

Dental anesthesia administration often triggers unpleasant sensations, particularly needle injection-related pain, which can evoke fear among patients, especially in the pediatric population. Vibration and low-level laser therapy (LLLT) have been extensively studied as potential methods for alleviating pain. Additionally, phentolamine mesylate (PM) has shown promise in reducing the duration of anesthesia. From a clinical perspective, inadequate control over the persistence of the anesthetic effect may lead to complications associated with its prolonged duration, such as self-injuries or functional impairments. This review aimed to systematically summarize and compare methods of alleviating pain during local anesthesia and reducing its duration. In November 2023, an electronic search was systematically conducted across PubMed, Web of Science, and Scopus databases using keywords (pain) AND (anesthesia) AND ((phentolamine) or (vibration) or (LLLT) OR (PBM)). The initial pool consisted of 495 records, from which 241 duplicates were eliminated. After careful examination of the remaining articles, 40 were included. The study adhered to the PRISMA guidelines. Most studies reported beneficial effects of LLLT and vibration; however, some did not corroborate these findings. Four studies had inconclusive results. Regarding anesthesia duration involving PM and LLLT, the majority of studies exhibited notable reductions, although no significant differences were revealed in 1 study. Vibration and LLLT appear to be advantageous methods in alleviating pain associated with local anesthesia administration. Phentolamine mesylate and LLLT are efficient in reversing local anesthesia.

A retrospective epidemiological analysis of maxillofacial fractures at a tertiary referral hospital in istanbul: a seven-year study of 1,757 patients

BackgroundThe aim of the study was to evaluate the etiology, incidence, demographics, and characteristics of maxillofacial fractures treated at a university hospital over a seven-year period.MethodsWe performed a retrospective analysis of 1,757 patients with maxillofacial fractures who were referred to our department between May 2012 and March 2019. The patients’ demographic and clinical characteristics were noted, as well as the fracture type, location, and etiology. The treatment modalities were also analyzed.ResultsA total of 2,173 maxillofacial fractures were seen in 1,757 patients. The male to female ratio was 3.9:1, and the mean patient age was 31.89 ± 17.70 years (range: 0–95 years). Maxillofacial injuries were most prevalent in the 19–28 years age group (23.9% of cases), with a general increase in injuries observed between 2013 and 2018 across all age groups. The most common etiological factor was assault (29.1%), followed by falls (26%). In male patients, assault was reported as the main cause, while in female patients, falls were identified as the main cause. The nasal bone was the most common site of fracture, followed by the maxilla. The average time from admission to surgery was 2.8 days, with local anesthesia being the most frequent surgical intervention. The average time from admission to surgery was 2.8 ± 2.5 days (range: 0–20 days), with surgeries performed under local anesthesia being more frequent than those carried out under general anesthesia. Among the surgical interventions, the most common general anesthesia technique for fracture reduction was open reduction and internal fixation with plates and screws. Plate exposure, wound-site infection, and temporomandibular joint ankylosis were the major complications encountered in the study population.ConclusionThe study reveals significant variability in maxillofacial fractures based on gender, age, and etiology. Assault emerged as the leading cause of these fractures, followed by falls and road traffic accidents. Men were affected by maxillofacial trauma four times more often than women, with the highest incidence occurring in the 19–28 years age group. Nasal fractures were the most frequently observed (78.7%), while condylar-subcondylar process fractures were the most common type of mandibular fracture. Given these findings, a targeted, lifelong prevention strategy focused on high-risk groups could significantly reduce the burden of maxillofacial trauma.

“Floating Island Flap”—A New Technique for the Reconstruction of Full-Thickness Lower Eyelid Defects with Spontaneous Healing (Folded V-Y Island Flap with Orbicularis Oculi Muscle)

Background: Due to the high incidence of malignant tumors of the lower eyelids and the widespread use of surgery for their treatment, the reconstruction of tissues in this area is a frequent task for surgeons. Methods for restoring full-thickness lower eyelid defects are often invasive, pose a significant risk of complications, and do not provide optimal results. Methods: The authors developed a simple technique for the reconstruction of full-wall defects of the lower eyelids. It is a V-Y-type musculocutaneous island flap from the lower eyelid, with the orbicularis oculi muscle folded in the upper part and partially left for spontaneous healing, called by the authors a “floating island flap”. Between 2012 and 2023, 39 patients were operated on using this method. Results: Surgical procedures performed under local anesthesia were well tolerated by the patients. The healing process was quick and well accepted. Complications were rare. The most common were: eye irritation and temporary swelling of the flap. In 37 patients, proper protection of the eyeball and good esthetic results were achieved; only in two cases was the cosmetic result assessed as poor. Corneal defects occurred in two cases and healed after conservative treatment. In no cases was reoperation necessary. Conclusions: The developed method is simple and effective. It can be widely used in the reconstruction of full-thickness defects of the lower eyelids.

Artificial Intelligence Chatbots (ChatGPT and Google Gemini) Versus Traditional Patient Information Leaflets for Local Anesthesia in Eye Surgery: Correspondence.

Artificial Intelligence Chatbots (ChatGPT and Google Gemini) Versus Traditional Patient Information Leaflets for Local Anesthesia in Eye Surgery: Correspondence.

Consensus Statement on Pain Management for Pregnant Patients with Opioid-Use Disorder from the Society for Obstetric Anesthesia and Perinatology, Society for Maternal-Fetal Medicine, and American Society of Regional Anesthesia and Pain Medicine.

Pain management in pregnant and postpartum people with an opioid-use disorder (OUD) requires a balance between risks associated with opioid tolerance, including withdrawal or return to opioid use, considerations around social needs of the maternal-infant dyad, and the provision of adequate pain relief for the birth episode that is often characterized as the worst pain a person will experience in their lifetime. This multidisciplinary consensus statement between the Society for Obstetric Anesthesia and Perinatology (SOAP), Society for Maternal-Fetal Medicine (SMFM), and American Society of Regional Anesthesia and Pain Medicine (ASRA) provides a framework for pain management in obstetric patients with OUD. The purpose of this consensus statement is to provide practical and evidence-based recommendations and is targeted to health care providers in obstetrics and anesthesiology. The statement is focused on prenatal optimization of pain management, labor analgesia, and postvaginal delivery pain management, and postcesarean delivery pain management. Topics include a discussion of nonpharmacologic and pharmacologic options for pain management, medication management for OUD (eg, buprenorphine, methadone), considerations regarding urine drug testing, and other social aspects of care for maternal-infant dyads, as well as a review of current practices. The authors provide evidence-based recommendations to optimize pain management while reducing risks and complications associated with OUD in the peripartum period. Ultimately, this multidisciplinary consensus statement provides practical and concise clinical guidance to optimize pain management for people with OUD in the context of pregnancy to improve maternal and perinatal outcomes.

A narrative review on the performance and outcomes of penile and scrotal surgery in the ambulatory setting.

Following the COVID-19 pandemic, surgical wait times have surged, creating a backlog in elective urological procedures. This review aims to address the need to explore ambulatory care for penile and scrotal surgeries, which can offer benefits by shifting these procedures away from traditional inpatient settings. Recent studies confirm the safety and efficacy of performing penile and scrotal procedures in an ambulatory setting using local anesthesia (LA) or loco-sedative techniques. Of 616 reviewed cases, over 90% of patients expressed high satisfaction with LA and reported minimal postoperative complications. Pain management advancements, particularly the use of liposomal bupivacaine, reduced the need for opioids postoperatively. Importantly, no intraoperative complications or hospital admissions were reported, and adverse events were managed conservatively. The data highlighted in this review supports a move towards outpatient surgeries as a safe alternative to inpatient care for select cases. This review highlights the strong potential for ambulatory urological surgeries to alleviate surgical backlogs significantly, while reducing strain on hospital resources, and maintaining high levels of patient satisfaction. As evidence continues to grow on the safety, feasibility, and effectiveness of LA in office-based procedures, expanding ambulatory urological will be quintessential in modernizing patient care and reducing healthcare burdens.

Regional Anesthesia With Pectoral Blocks as a Non-inferior Approach for Mastectomy Analgesia: A Quality Improvement Study

Regional Anesthesia With Pectoral Blocks as a Non-inferior Approach for Mastectomy Analgesia: A Quality Improvement Study

Hydrodissection technique for pain relief during peri-microwave ablation in patients with subpleural non-small cell lung cancers.

This study aimed to assess the application value of the hydrodissection technique (HT) for pain relief during peri-microwave ablation (MWA) in patients with subpleural non-small cell lung cancers (NSCLCs). This retrospective study comprised 218 patients with subpleural NSCLCs who underwent computed tomography (CT)-guided percutaneous MWA. The patients were divided into two groups: HT-assisted MWA (HT group) and local pleural anesthesia (LPA)-assisted MWA (LPA group). Differences in the effective rates of pain relief during MWA, visual analog scale (VAS) scores post-MWA, complications, and complete ablative rates were assessed. The HT group comprised 101 patients (62 males and 39 females; mean age, 61.93 ± 10.57 years), while the LPA group comprised 117 patients (66 males and 51 females; mean age, 62.95 ± 11.16 years). The effective rate of pain relief in the HT group (82/101 patients, 81.19%) was significantly higher than that in the LPA group (66/117 patients, 56.41%), (p < 0.0001). The VAS scores at 6, 12, 24, and 48 h post-MWA were not statistically different between the two groups. The incidence of pneumothorax (grade ≥3) was significantly lower in the HT group (11/101 patients, 10.89%) than in the LPA group (27/117, 23.07%), (p = 0.0161). The complete ablative rates at 1, 3, 6, 12, and 24 months post-MWA were comparable of two groups. These results indicate that HT-assisted MWA of patients with subpleural NSCLCs could effectively provide pain relief and decrease the occurrence of pneumothorax, yielding a satisfactory local therapeutic response.

Infections and Patient Satisfaction in WALANT Hand Surgery in a Hospital Procedure Room.

Background: Wide-awake hand surgery has allowed many hand procedures to be moved out of the operating room and into minor procedure rooms while increasing efficiency, maintaining safety, and reducing both patient and hospital costs. The goal of this study was to evaluate patient satisfaction and postoperative complications of wide-awake local anesthesia with no tourniquet procedures performed in a community-based hospital procedure room. Methods: A total of 786 patients underwent 948 elective hand procedures in a hospital procedure room. At the conclusion of their surgeries, the patients were surveyed regarding their satisfaction. Following surgery, patients were evaluated for postoperative complications including infections. The trend in postoperative infection rates across 8 age groups was analyzed using a Cochran-Armitage test in R. Results: The overall infection rate was 6.2% (n = 59). All infections were superficial. Carpal tunnel had the highest number of infections (n = 25), followed by trigger finger (n = 8), and the combination trigger finger with carpal tunnel (n = 7). All infections were managed with antibiotics and/or soaks. Three patients did require a return to the operating room for irrigation and debridement. Ninety-nine percent of patients said the procedure room experience was better or the same as going to the dentist, would recommend wide-awake anesthesia to a friend or family member, and would undergo the procedure again. Conclusion: Wide-awake procedures performed in a hospital procedure room have low infection rates with high patient satisfaction.

Removal of soft tissue foreign bodies in the hand under microscopy: a retrospective observational study

Purpose: Numerous studies have focused on techniques for detecting foreign bodies in soft tissue in the hand, but removal remains a subject of interest. In this study, we describe the microscope-assisted removal of foreign bodies in the hand. Methods: We reviewed records of patients treated for foreign bodies in the hand at our department from July 2013 to May 2023. In 16 patients aged 23 to 55 years, the following variables were analyzed: the cause of trauma; the time interval from trauma to surgery; the location, type, size, and number of foreign bodies; patient complaints; imaging technique; and procedure type. Under local anesthesia, a slit incision was made at the suspected site. Foreign bodies were completely removed using micro-instruments under microscopic guidance. Results: Stab injuries were the most common (n=13), and there was one case each of abrasion, traffic accident, and bee sting. The middle finger (n=5) was the most affected, followed by the thumb (n=4), index (n=3), little finger (n=2), ring finger (n=1), and palm (n=1). Foreign bodies included glass (n=6), wood (n=4), seashell (n=2), fish bone, a pencil tip, a bee stinger, and metal. Their size ranged from 1 to 20 mm. Patient complaints included a foreign body sensation, localized pain, swelling, discoloration, and a skin lesion. X-ray examinations were performed in all cases, and ultrasonography was conducted in five cases. Conclusion: A microscopic approach allows precise, safe, and complete removal of foreign bodies without tissue damage, highlighting the efficacy of this technique in hand surgery.

Mohs Micrographic Surgery: A Brief Overview

AbstractMohs micrographic surgery (MMS) is a tissue-sparing skin cancer resection technique that involves 100% margin analysis. This procedure is performed in the outpatient setting under local anesthesia by dermatologic surgeons who act as both the surgeon and the pathologist. The technique allows for prompt reconstruction immediately after cancer clearance and offers the highest cure rate for many skin malignancies, including basal and squamous cell carcinoma, as well as more rare tumors. Mohs surgery effectively ensures cancer clearance while minimizing defect size and optimizing cosmetic and functional outcomes for patients. Herein we will discuss the evolution, procedure, and indications of MMS.

A Comparative Evaluation of Efficacy of Local Infiltration of Sodium Bicarbonate Buffered Local Anesthesia with Epinephrine Vs Non-Buffered La with Epinephrine: A Clinical Study

Background: The aim of the study was to compare the efficacy of local infiltration of sodium bicarbonate buffered local anaesthesia with epinephrine vs non- buffered local anaesthesia with epinephrine.  Method: Patients having periapical infection in the maxillary anterior and premolar region were selected for the study. A total of 50 patients were included in the study. In group A, 8.4% sodium bicarbonate buffered 2% Lignocaine with 1:80,000 adrenaline was used for local infiltration for extraction. In group B, 2% Lignocaine with 1:80,000 adrenaline (non-buffered) was used for local infiltration for extraction. The onset of anesthesia, was compared between group A and group B. Data was tabulated and statistical analysis was carried out using paired t-test.  Result: The inter-group difference in onset of anesthesia,was assessed using paired t-test and highly significant difference was found between group A and group B (p≤0.05).  Conclusion: Significant improvement seen in onset of anesthesia and duration of anesthesia.

Practice and challenges related to regional anesthesia in Amhara regional hospitals, Northwest-Ethiopia: a web-based survey study

BackgroundRegional anesthesia (RA) can improve patient outcomes and reduce perioperative complications including deaths. Despite its benefits, RA is less utilised in low-resource settings. The purpose of this study was to assess practice and challenges related to RA in Amhara Regional Hospitals, Northwest-Ethiopia.MethodsA web- based survey was distributed among 360 anesthetists working in Amhara Regional Hospitals, Northwest-Ethiopia from November 15 - January 30, 2023. An English, semi-structure, self-administered questionnaire was disseminated by email and telegram following ethical clearance. The survey included questions about the use of RA, socio-demographic characteristics of anesthetist, types of practiced regional blocks, and barriers to perform RA. All volunteer respondents who filled online questionnaire during study period were included. The data were coded and analyzed using statistical package for social Sciences (SPSS) software-version 20. Both inferential and descriptive statistics were used to describe the results.ResultsThe overall response rate was 63.3% (223 out of 360 completed surveys). A total of 132 respondents (36.7%) did not provide a response, and 5 respondents (1.4%) submitted incomplete) surveys. The most frequently self-reported barriers to performing peripheral nerve blocks were a lack of equipment (regional procedure kit including block needle, ultrasound, nerve stimulator, or epidural set) 185 (82.9%), lack of knowledge 171(76.7%), lack of practical skills 112 (50.2%), and lack of drugs/medication 50 (22.4%).ConclusionsThe principal findings indicate that all respondents perform spinal anaesthesia, while the practice of peripheral RA varies. Reported barriers to performing RA are related to knowledge and training, as well as a lack of equipment (there aren’t enough regional procedure kits available that include an epidural set, block needle, nerve stimulator, and ultrasound). A more stringent approach with specific requirements, distinguishing between neuraxial and peripheral blocks, enhance training opportunities for peripheral nerve blocks are required in Ethiopia.