A Prospective Audit of Peripheral Nerve and Plexus Blockade in Australia and New Zealand.

The Australian and New Zealand prospective audit of peripheral nerve and plexus blockade aims to determine the incidence of permanent neurological complications following peripheral nerve/plexus blockade. In addition, non-neurological side-effects and quality markers of clinical practice including efficacy, patient satisfaction and recovery are recorded. This project has full support from the Regional Anaesthesia Special Interest Group.

Large scale studies such as the one by Auroy indicate that the incidence of neurological complications following peripheral nerve/plexus blockade are rare (1). However clinical practice is evolving with the increasing use of ultrasound to locate and block nerves/plexuses and with that new operators and procedures. The audit aims to collect data from tens of thousands of patients so that rare complications may be determined, and also so that precursors to adverse events may be detected. It has clear methodology, well defined follow-up procedures and uses standardised definitions (2) all of which were of variable quality in previous studies (3).

Data entry is via an online database www.regional.anaesthesia.org.au. Registering as a test user and entering test data (which will later be deleted) facilitates familiarity with this project. A test user can later be converted to a full registered user. The web-based interface facilitates ease of data entry, multi-centre collaboration and capture of other data so that the incidence of non-neurological complications can also be established (2). The initial data entry takes 2 mins and it is recommended that it occurs online in the intraoperative period facilitating accurate data collection. It is also recommended that the local coordinator(s) have a hands-on approach and ideally have some non-clinical time allocated to this project. An alternative method of validating the denominator data should be established at each site. Postoperative follow-up occurs at 24 – 48 hrs (efficacy and block recession data) and for potential neurological complications at 7-10 days using a standardised online questionnaire. Reminders regarding follow-up are received via email. An important requirement is a commitment to the provision of a quality data collection process such that all relevant data from all patients are collected.

A clinical pathway for neurological assessment and investigation has been established following a recent study (4). Triggers for referral, the referral pathway, and the standardised neurological questionnaire are located at www.regional.anaesthesia.org.au. A collaborative approach with a neurologist with expertise in peripheral neuropathies and nerve conduction studies is essential.

This project offers a unique opportunity for anaesthetists from Australia and New Zealand to collect data following peripheral nerve/plexus blockade. When completed it should be of value to anaesthetists worldwide. Anaesthetists from Anaesthesia groups and departments (public, private, large or small) are invited to participate in this project. To learn more visit www.regional.anaesthesia.org.au.

1. Auroy Y, Benhamou D, Bargues L, Ecoffey C, Falissard B, Mercier FJ, Bouaziz H, Samii K. Major complications of regional anesthesia in France: The SOS Regional Anesthesia Hotline Service. Anesthesiology 2002;97:1274-80.
2. Schulz-Stubner S, Kelley J. Regional Anesthesia Surveillance System: first experiences with a quality assessment tool for regional anesthesia and analgesia. Acta Anaesthesiol Scand 2007.
3. Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg 2007;104:965-74.
4. Watts SA SD. Long-term neurological complications associated with surgery and peripheral nerve blockade: outcomes after 1065 consecutive blocks. Anaesth Intensive Care 2007;35:24-31.

Dr Michael Barrington
Project Coordinator
Department of Anaesthesia
St Vincent’s Hospital, Melbourne
michael.barrington@svhm.org.au


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