Michael Barrington1, Rowan Thomas1, Samuel Gledhill1, Steve Watts2, Valerie Tay1

1St Vincent’s Hospital, Melbourne, Australia
2Sir Charles Gairdner Hospital, Perth, Australia

Introduction: Quality in regional anesthesia includes efficacy, efficiency and safety. A study by Auroy indicates that the incidence of neurological complications following peripheral nerve/plexus blockade is rare (1). Auroy’s data was collected from patients who largely had regional anesthesia performed using nerve stimulation. However the use of ultrasound in clinical practice to locate and block nerves/plexuses is evolving and regional anaesthesia (RA) is increasingly being used as an anaesthesia technique and for postoperative analgesia. The collection of prospective data is important for an effective regional anaesthesia service where the advantages can be balanced against defined disadvantages. The objective of the Australian and New Zealand prospective audit of peripheral nerve and plexus blockade is to determine the incidence of permanent neurological complications following peripheral nerve/plexus blockade. In addition, non-neurological complications and quality markers of clinical practice including efficacy, patient satisfaction and recovery are recorded. The project aims to prospectively collect data from tens of thousands of patients from our current practice in Australia and New Zealand so that both the incidence of rare complications and their precursors can be determined. This project has clear methodology and follow-up procedures and uses standardised definitions (2) which were variable in previous studies (3). Recently it has been suggested that a large multicentre prospective trial may provide a reliable and valid method to capture the incidence of neurological complications following RA (3). In this study we have developed a web based data collection and reporting system that is suitable for multicentre data collection and collaboration. This project has full support from the Regional Anaesthesia Special Interest Group.

Methods: Data entry is via an online database www.regional.anaesthesia.org.au. Registering as a test user and entering test data (which is later deleted) facilitates familiarity with this project. A test user can later be converted to a registered user. The web-based interface facilitates ease of data entry and capture of other data so that information regarding non-neurological side-effects, efficacy, patient satisfaction and recovery can be obtained. The initial data entry takes 2 minutes and it is recommended that it occurs online in the intraoperative period facilitating accurate data collection. Data collected includes patient, surgical and anaesthetic data. No data identifying the patient is collected. An alternative method of validating the number of procedures performed is established at each site. Postoperative follow-up occurs at 24 – 48 hrs (efficacy and block recession data) and for potential neurological symptoms/complications at 7-10 days using a standardised online questionnaire. Reminders regarding follow-up are received via email 10 days postoperatively. Follow-up is the responsibility of each site. It is recommended that the local coordinator(s) have a hands-on approach and ideally have some non-clinical time allocated to this project. An important requirement is a commitment from each site/practice to the provision of quality data collection process so that all relevant data from all patients is collected.

A clinical pathway for neurological assessment and investigation has been established following collection of preliminary data and results of 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.

Results (preliminary): In 2007 over 2500 procedures were recorded on the database. Examples of patients referred to neurologists are tabulated below.

Conclusion: 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. To date 6 hospitals are involved in this project, however Anaesthetists from Anaesthesia groups and departments (public, private, large or small) from all over Australia and New Zealand are invited to participate in this project. To learn more visit www.regional.anaesthesia.org.au and/or contact the project coordinator, Dr Michael Barrington (michael.barrington@svhm.org.au). For administrative and IT support contact Sam Gledhill on samuel.gledhill@svhm.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.