Local and regional anaesthesia
Background and Goal of Study: Peripheral nerve blocks (PNB) form an important part of anaesthetic practice. Clear documentation of the procedure and patient consent is vital. A standardized PNB procedure note form has been developed in the USA as a way to improve documentation (1). Our objective was to review our current standards of PNB documentation and asses the need for a standardized form.
Materials and Methods: In a tertiary referral centre for elective orthopaedic surgery, key data was prospectively collected from 100 consecutive patients where the anaesthetic technique involved PNB.
Results and Discussions: A total of 145 individual PNBs were performed in 100 patients. Only 31% of records noted which major complications had been discussed with the patient prior to PNB. In 42% of records it was not obvious which anaesthetist had performed the PNB. Aseptic technique was noted on only 27% of records. Nerve stimulation threshold was not noted in 21% of blocks. Negative aspiration prior to injection was noted in 20% of records, normal resistance on injection in 16% and immediate disappearance of muscle twitch on injection was never noted. Absence of pain or paraesthesia on injection was only noted in 7% undergoing PNB awake.
Conclusion(s): This study highlights the variable extent of PNB documentation in the anaesthetic records. Regardless of clinical expertise, this may be indirectly seen as evidence of a poor standard of anaesthetic care (2). We propose the introduction of a standardized PNB procedure form, and commend the work of Gerancher et al (1).
1 Gerancher JC, Viscusi ER, Liguori GA, et al. Development of a Standardized Peripheral Nerve Block Procedure Note Form. Reg Anesth Pain Med
2 Smith A. New College Guidelines for Anaesthetic Records. The Royal College of Anaesthetists 1997. Newsletter 36:3-5.