Safety of Regional Anesthesia in Ukraine Survey: Are Hospitals Ready for the Local Anesthetic Systemic Toxicity (Last)?

Abstract

Background. A survey was conducted among anesthesiologists in 38 Ukrainian hospitals to evaluate the current incidence and treatment quality of the local anesthetic systemic toxicity (LAST). With the growing preference for regional anesthetic techniques, implementation of measures for timely detection and treatment of LAST is becoming a priority for many surgical hospitals. This study aims to provide primary country-wide epidemiological data to guide further safety improvement in Ukraine.
 It should be noted, that the survey was performed before the beginning of the full-scale Russian invasion of Ukraine. The resulting surge in the incidence of limb injury has resulted in an unprecedented scale of application of regional anesthesia, including out-of-hospital cases with very limited monitoring, which will no doubt generate great amount of new data on the subject. We hope that our current analysis may be used as a reference point for the future research on this subject.
 Material and methods. A link to the survey was distributed via e-mail to the members of the Association of Anesthesiologists of Ukraine. Data submission was anonymous. Statistical analysis was performed using Microsoft Excel. Descriptive statistics are provided.
 Results. Responses were submitted by 186 anesthesiologists from 38 Ukrainian cities. Among them, 65.9% practice in public hospitals, 25.4% - in private hospitals, 8.7% - in university hospitals. Majority of respondents (60.3%) reported performing over 100 regional anesthetic procedures per year. Peripheral nerve blocks were routinely performed in the hospitals of 76.9% of respondents. 42.4% are using peripheral nerve blocks or more times per week, 24.4% perform this amount monthly, 21.7% - yearly, with 11.5% not utilizing peripheral nerve blocks at all.
 Ultrasound guidance was commonly used by 64.1% of anesthesiologists, 60.3% reported relying on landmark techniques often and 38.5% are routinely using a neuromuscular electrical stimulator.
 LAST cases were previously encountered by 37.2% of respondents. However, only 37% have reported having a LAST protocol in their hospital and 42.3% did not have a lipid emulsion available. Regarding patient education, in 62.8% of cases the patients were specifically warned about the possible complications of regional anesthesia prior to procedures, where it was performed. When the local anesthetic related adverse events did occur, they were recorded in the patient’s card in 27.2% of cases; the chief of anesthesiology department was informed in 36.9%, while in 35.9% the event was not reported in any way.
 Conclusions. The practice of regional anesthesia is becoming more widespread in Ukraine, but the minimal measures required to provide patient safety during such procedures are still not being employed in many hospitals.