Regional Anaesthesia (AURORA) · PDF fileAustralian and New Zealand Registry of Regional Anaesthesia (AURORA) Overview of Results First 4000 procedures recorded to -

Australian and New Zealand Registry of

Regional Anaesthesia (AURORA)

Overview of ResultsFirst 4000 procedures recorded to -

www.anaesthesiaregistry.orgJune 1st 2011 to February 2012

Tuesday, 27 March 12

http://www.anaesthesiaregistry.org


Background• Australian and New Zealand Registry of

Regional Anaesthesia (AURORA)

• Objective: Determine the Quality and Safety of Peripheral Regional Anaesthesia

• Registry methodology - captures ‘native’ clinical behaviour

• Web interface: www.anaesthesiaregistry.org

• Blog: www.regionalanaesthesia.wordpress.com




http://www.regionalanaesthesia.wordpress.com

http://www.regionalanaesthesia.wordpress.com

Clinical registries

• Complete inclusion of all eligible patients

• Capture ALL episodes of peripheral regional anaesthesia performed by ALL practitioners on ALL patients

• Reduce selection bias


Patient characteristicsCharacteristic

Age (yr, mean ± SD) 58 ±19

Weight (kg, mean ± SD) 80 ± 19

Height (m, mean ± SD) 1.68

Gender (M/F), % 49/51

ASA status (I/II/III/IV), % 20/39/36/5

Diabetes, % 17


Patient and practice characteristicsCharacteristic %

Cancer 6

Emergency 27

After Hours 13

Chronic analgesic use 18

Neurological disease 10


Chronic analgesis use

Chronic analgesia n(%)

No 2544 (82)

Regular panadeine forte or similar

175 (6)

Regular oxydodone, opioid patches or similar

290 (9.4)

Antineuropathic drugs 63 (2)

Advanced therapy (pain pump) 11(0.3)


Neurological diseaseNeurological disease n(%)

Peripheral neuropathy 73 (2.4)

Diabetic neuropathy 112 (3.6)

Demyelinating disease, Carpal tunnel syndrome, Ulnar neuritis 13 (0.3)


Neurological diseaseNeurological disease n(%)

CVA with deficit 26 (0.8)

Post-surgical/traumatic 112 (0.9)

Spinal stenosis, Disc herneation, compressive

radiculopathy21 (1)

Other 91 (2.9)

Multiple diagnoses 10 (0.3)

None 2780 (90)


Types of surgery

11%

4%

17%

2%

13%9%4%

25%

4%10%

1%0%

Shoulder, proximal, humerus, clavicleHumerus, elbowForearm, hand, wristThoraxAbdomenHipFemur, thighKneeLegAnkleNeckNot assoc. with surgery


Block type (category) Interscalene

Supraclavicular

Infraclavicular

Axillary

Paravertebral

Trunk

Femoral

Sciatic

L.L./U.L. other0 7.5 15 22.5 30

%



Timing n (%)

Preoperatively 3160 (79)

In immediate postoperative period 769 (19)

In postoperative period after departing PACU 23 (0.5)

Unrelated to surgery 29 (0.7)


Block purpose n (%)

Intraoperative anaesthesia 123 (3)

Postoperative analgesia 2311 (58)

Both Anaesthesia and analgesia 1466 (37)

Postoperative analgesia inserted postoperatively

33 (0.8)

Analgesia unrelated to surgery 25 (0.6)

Rescue block 22 (0.5)

Chronic pain 3 (0.08)


Block category-femoral

Operative region FNB%

Fascia iliaca

%

Total,n

Hip joint, neck of femur 44 56 209

Femur and thigh 74 26 126

Knee and popliteal region 97 3 874

Leg (below knee, above ankle) 93 7 46

Ankle foot/toes 88 12 17

Unrelated to surgery 100 2


Block category-trunkOperative region = Abdominal cavity and wall

Block type n (%)

Transversus abdominis plane - posterior 465 (72)

Transversus abdominis plane - subcostal 100 (15)

Ilioinguinal/iliohypogastric 60 (9)

Rectus sheath 20 (3)

Genitofemoral 3 (0.4)

Intercostal 1 (0.1)


Block category-paravertebral

Operative region Total,n (%)

Neck 2 (0.9)

Abdominal wall 16 (7)

Hip joint, neck of femur 135 (58)

Femur and thigh 12 (5)

Knee and popliteal region 6 (3)

Thorax 60 (26)


59%

28%

7%6%

Ultrasound aloneUltrasound and Nerve stimulatorNerve stimulator (alone)Landmark

13%

50%

30%

7%

2006- 2008 2011- 2012

Technology used to located nerves


Single-shot or catheter

76%

22%

2%

Single-shotCatheter (Non-stimulating)Stimulating Catheter


Catheter by block category

0

12.5

25

37.5

50

ISB SCB ICB AX PVB Trunk Femoral Sciatic

Catheter as % of block type/category


Barrier protection

If no catheter used

68%

12%

20%

Sterile GlovesGown, gloves and maskNon-sterile gloves


Barrier protection

If catheter technique used

15%

84%

1%

Sterile GlovesGown, gloves and maskNon-sterile gloves


Probe cover

72%

18%

10%

Sterile probe coverSimple dressing (e.g. Tegaderm)None

as a % of procedures performed with ultrasound


Probe cover

97%

3%0%

Sterile probe coverSimple dressing (e.g. Tegaderm)None

as a % of catheter techniques performed with ultrasound


Level of sedation (during block insertion)

21%

51%

4%

24%

Alert and AwakeLight sedationModerate sedationUnresponsive to noxious stimuli


Level of sedation (as function of block category)

0

20

40

60

80

BP Paravert. Trunk Lower Limb

% Block category

BP = brachial plexus


Level of sedationBlock category = Femoral

0

15

30

45

60

1 2 3 4

% Femoral

1, Alert2, Light sedation3, Moderate sedation4, Unresponsive


Blocks performed with patent unresponsive as a function of hospital/practice

0

17.5

35

52.5

70

1 20 21 26 36 39 41 55 56 57 61 64

% Blocks unresponsive

Hosp IDTuesday, 27 March 12

Local anaesthetic

85%

8%

4%4%

RopivacaineLignocaineBupivacaineLevobupivacaine


Local anaesthetic dosage (ropivacaine), mg/kgLocal anaesthetic dosage (ropivacaine), mg/kg

Period Mean (SD)

2006 - 2008 2.0 ± 0.9

2008 - 2011 1.7 ± 0.9

2011 - 2012 1.4 ± 0.7

dosage for single blocks only


30%

53%

13%3%1%

SuccessfulSuccessful-GA otherSuccessful-Neuraxial otherIncomplete block failureFailure

Success of block


Immediate complications

Immediate Complications nMajor Local Anaesthetic toxicity 2Puncture of major artery or vein 18Haematoma 7Respiratory depression arrest 1Unintended paraesthesia 41Horner’s syndrome 2Intraneural injection 3Unintentional removal of catheter 3Wrong site block 1

First 4000 procedures - www.anaesthesiaregistry.orgJune 1st 2011 to February 23rd 2012




PACU analgesia typeAnalgesia type %

None 60IV Opioid 19

Oral opioids 2Paracetamol 5

Tramadol 1LA bolus 2

Repeat block 0.7Preemptive 4

Outside surgical area 1

results from one hospital only


Day 1 complicationsDay1 Complications nBlock failure requiring opioids 64Unintentional removal of catheter 9Readmission for poor pain relief 2Haematoma 5Motor block impairing mobilisation 33Technical problem, kink, leak, disconnection 33Pain, bruising at site 24Horner’s syndrome 4None 2719





Patient-rated outcomes

2%1%1%

17%

64%

15%

Completely dissatisfiedDissatisfiedNot satisfied, nor dissatisfiedSatisfiedCompletely satisfiedUnable to answer

Potential sample = 278233 (83%) completedResponses (%) based on completed questionnaires

Q 1. To what degree were you satisfied about the explanation of the regional anaesthesia (nerve block) procedure?

Hospital with high followup



2%2%

18%

63%

15%



Q 2. To what degree were you satisfied about the amount of information about the regional anaesthesia (nerve block) procedure?




53%25%

6%4%

12%

NoneMild - barely noticeableModerate - definitely noticeableSevere - very preoccupied by the symptomUnable to answer


Q 3. To what degree did you experience pain during the regional anaesthesia (nerve block) procedure?




33%

34%

20%

10% 4%



Q 4. To what degree did you after the operation have pain?




80%

12%5%0%2%



Q 5. To what degree did you after the operation have vomiting?




54%26%

11%4%4%



Q 6. To what degree after the operation, did numbness or heaviness of the anaesthetised limb or body part bother you?




19%

37%

19%

17%

7%



Q 7. When the numbness/heaviness related to the nerve block wore off, how much pain did you experience?




13%

26%

35%

19%

7%



Q 7. When the numbness/heaviness related to the nerve block wore off, how much pain did you experience?

Hospital with lower followup rate



1%1%

21%

64%

12%



Q 8. To what degree did your anaesthetist show undestanding for your situation?




1%1%17%

66%

15%



Q 9. To what degree did your anaesthetist pay attention to complaints like pain and discomfort?




1%17%

67%

15%



Q 10. To what degree did your anaesthetist pay attention to your questions?




83%

7%

10%

Yes NoUnable to answer


Repeat OK. Were you to require a similar operation again, would you be happy to have the same type of a regional anaesthetic again?



Follow-up methods

74%

18%

2%2%

3%

Phone Ward visitHistory review Clinic visitLetter


Follow-up rates

91%

1%

0%

1%2%

5%

SuccessfulDementiaDeceasedLanguageOtherUnsure


Pain at Delayed Follow-up

45%

37%

15%2%

NoneMild - barely noticableModerate - definitely noticableSevere -definitely preoccupied by the symptom


Delayed Complications n

Neuropathy consistent with nerve/plexus blockde 3

Postoperative neurological symptom 131Pain/bruising at injection site 37Infection 13Specific mononeuropathy 3

Neurology outside the nerve/plexus region 14

Postoperative neuropathy unrelated to RA 15

Neurology (surgery) 80

None 2581





End of AURORA overview


Documents

Regional Anaesthesia (AURORA) · PDF fileAustralian and New Zealand Registry of Regional Anaesthesia (AURORA) Overview of Results First 4000 procedures recorded to -