50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

Changes in Nerve Block Procedural Volume Associated with the Implementation of a Regional Anesthesia Consult Service

Alexander Loji MD, Ruba Sajdeya MD, PhD, Matthew Fuller MS, Becky Schroeder MD, Miriam Treggiari MD, PhD, Austin Traylor MS, Lisa M. Einhorn MD

INTRODUCTION

-Benefits of regional anesthesia (RA): less postoperative opioid requirements, faster recovery time, lower post-operative pain scores, and improved patient satisfaction.1

-RA has continued to expand over the last two decades.2

-Many patient-, provider-, and system-level barriers remain

-To mitigate these constraints, our institution implemented a regional anesthesia consult service (RACS) to allow for broader access

-Study Purpose: retrospectively review the impact of this service on institutional RA procedural volume over time.

METHODS

-Design: Single-center retrospective cohort studying pediatric and adult patients undergoing surgery at Duke University Hospital from 1/1/2016 to 9/1/2024

-Intervention: The primary exposure was the implementation of the service on 10/29/2018

-Primary Outcome: pre/post intervention utilization of regional blocks (following 6-month phase in period)

-Secondary Outcomes: Utilization of regional anesthesia in specialty populations and utilization by surgical services

-Exclusion Criteria: Children < 1 year, emergency service, obstetric populations, GI/bronchoscopy procedures, eye surgery, cardiac catheterization procedures, intracranial neurosurgeries, or any other case in which a RA was not indicated

CONCLUSIONS

-Prior to the RACS: 21.9% of cases received a regional anesthetic

-After the RACS: 24.7% of cases following the intervention (p < 0.001)

-increase in proportion of both truncal blocks (2.1% to 3.3%) and peripheral nerve blocks (20.1% to 21.6%) following the intervention.

-Orthopedic Surgery had the highest utilization by surgical specialty both pre/post intervention (61.3% to 62.5%)

-General surgery ( 10.3% to 14.6%) and urology (2.1% to 4.5%) saw the largest increase in utilization post intervention

-No increase in block utilization by plastic surgery or pediatric surgery

FUTURE DIRECTIONS

-Conducting a segmented regression analysis for an interrupted time series model

-Determining block utilization by specific surgery type, utilization of RA in non-RA trained anesthesiologist cases, consults placed by quarter

50th Annual Regional Anesthesiology and Acute Pain Medicine Meeting

CHANGES IN NERVE BLOCK PROCEDURAL VOLUME ASSOCIATED WITH THE IMPLEMENTATION OF A REGIONAL ANESTHESIA CONSULT SERVICE

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