The Effectiveness of Regional Anaesthesia before and after the Introduction of a Dedicated Regional Anaesthesia Service Incorporating a Block Room

Abstract

Dedicated regional anaesthesia services incorporating block rooms and/or block teams may facilitate theatre efficiency and improve training in regional anaesthesia. Currently, it is unknown if a dedicated regional anaesthesia service improves the effectiveness of regional anaesthesia. In November 2013, the Royal Brisbane and Women's Hospital established a dedicated regional anaesthesia service comprising a block team and a block room. Pre-intervention (conventional model of care) registry data was retrospectively compared with post-intervention (dedicated regional anaesthesia service) audit data, with regard to pain and opioid requirement in the post-anaesthesia care unit (PACU). The primary outcome was inadequate analgesia, defined as a numerical rating scale (NRS; 0, no pain; 10, worst pain imaginable) for pain >5 in the PACU. Pre- and post-intervention, 43.7% and 27.7% of patients respectively reported a NRS >5 (P <0.001). A difference in the type of blocks and surgery performed may have accounted for the improved outcome seen post-intervention. After adjustment for American Society of Anesthesiologists physical status, block type and surgery type, the odds ratio of having inadequate analgesia (NRS >5) was 0.54 (95% confidence interval 0.39 to 0.76) for post-intervention compared to pre-intervention. Secondary outcomes examined pre- and post-intervention were the absence of pain (39.3% and 55.1% of patients, respectively, P <0.001), systemic opioid analgesia requirement (48.6% and 30.5% of patients respectively, P <0.001) and median maximum NRS (4 [interquartile range (IQR) 0 to 8] and 0 [IQR 0 to 6] respectively, P <0.001). A dedicated regional anaesthesia service was associated with improved effectiveness of regional anaesthesia.

Research priorities in regional anaesthesia education and training: an international Delphi consensus survey

“…Many institutions have dedicated RA ‘block rooms’, but measuring effectiveness of this initiative remains elusive. A recent article, published after this study commenced, found that surrogate measures of analgesia, pain scores and opioid consumption were reduced after introduction of a block room 22…”

Recommendations and resources for regional anaesthesia Fellowships in Australia and New Zealand

“…Novel approaches to education and clinical practice should be encouraged. For example, while uncommon in Australia and New Zealand, instituting RA block teams allows for more focused training opportunities with the added benefit of increased workflow efficiency, 11,12 improved block effectiveness as measured by pain scores 13 and decreased failure rate. 12…”

Factors associated with low levels of patient satisfaction following peripheral nerve block

“…This service utilises a block room/block team model of care, which has been described previously. 8 Data were entered contemporaneously at the time of the block and used primarily for quality assurance purposes, but also for long-term clinical follow-up of abnormal neurological findings. Ethics approval was sought prior to data analysis, and an ethics exemption was granted by the RBWH human research and ethics committee (LNR/2018/ QRNBW/47772).…”