INTERNATIONAL SURVEY OF PEDIATRIC REGIONAL ANESTHESIA PRACTICES
Identifying opportunities for improving efficiency in pediatric regional anesthesia
Peyman Heidari, Niveditha Karuppiah, and Isabella Jaramillo
INTRODUCTION
•The benefits of regional anesthesia (RA) in adult care—including time and cost savings in block rooms—are well-documented.
•However, in Pediatrics, RA is often performed under general anesthesia (GA) as part of a multi-modal analgesia strategy, rather than as an alternative to GA.
•Limited data exists on global practice patterns—particularly factors influencing RA efficiency and effectiveness.
•We aimed to investigate current pediatric RA practices worldwide to identify opportunities for improving efficiency.
METHODS
•We developed a survey with key questions regarding the practice of pediatric RA globally—such as when blocks are done, block room availability and use, presence of RA fellowship-trained staff, use of pre-packaged block kits versus a la carte, and so on.
•The survey was distributed via publicly-available emails, social media, and word of mouth. We primarily targeted English-speaking institutions but distributed the survey to sites across 6 continents.
•Responses were analyzed using descriptive statistics and answers were expressed as percentages of total respondents.
RESULTS
•Till date, 91 responses from 26 countries across six continents have been collected.
•The majority of respondents (over 90%) do not have dedicated block rooms, and RA blocks are most commonly performed in the operating room under GA.
•Only 40% of institutions have block carts readily available, and just 24% provide pre-packaged block kits for pediatric cases.
•While 58% of sites have RA fellowship-trained staff, the presence of a dedicated anesthesiologist specifically performing blocks is rare (60% report no such staff).
•Notably, 22% of respondents indicated that surgeon support for pediatric RA was less than 50% at their institutions, and only 47% of respondents reported support of >80%.
•Other findings are indicated in Fig 1
DISCUSSION
•Our findings highlight key information about the global practice of pediatric RA and identify areas for improvement in RA delivery.
•Blocks were mostly done under GA in the operating room, with few sites having access to or utilizing a dedicated block room, suggesting efforts to improve efficiency must look outside of the block room.
•Most institutions have RA fellowship-trained staff who are valuable resources for providing education and institution-specific guidance in improving pediatric RA practice.
•Premade pediatric block kits and stocked block carts appear to be an underutilized resource that many institutions could stand to benefit from.
•Future work should assess the benefits of resources such as premade pediatric block kits and block carts, readily available ultrasound machines, as well as education and delivery of RA by fellowship-trained anesthesiologists, all of which are opportunities for improving efficiency in pediatric RA practice worldwide.
REFERENCES
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3) Merella, F., Canchi-Murali, N., & Mossetti, V. (2019). General principles of regional anaesthesia in children. BJA Education, 19(10), 342–348.
