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Standards of peripheral nerve block procedure documentation: a review of practice: A-495

Paul, R.; Rutter, S.

European Journal of Anaesthesiology (EJA): June 2006 - Volume 23 - Issue - p 129
Local and regional anaesthesia

Nuffield Department of Anaesthesia, Oxford, United Kingdom

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).

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1 Gerancher JC, Viscusi ER, Liguori GA, et al. Development of a Standardized Peripheral Nerve Block Procedure Note Form. Reg Anesth Pain Med 2005; 30:67-71.
2 Smith A. New College Guidelines for Anaesthetic Records. The Royal College of Anaesthetists 1997. Newsletter 36:3-5.
© 2006 European Society of Anaesthesiology