Both pharmacologic and behavioral means are frequently used to

provide anxiolysis and analgesia during regional anesthesia

Pain catastrophizing = negative cognitive-emotional response to anticipated

or actual pain

→ associated with: anxiety + procedural pain

→ can be scored: Pain Catastrophizing Scale (PCS)

Prior quantitative studies demonstrated patients with high PCS scores (≥10)

experienced a benefit of sedation with significantly less maximal procedural

pain with sedation compared to education/reassurance, than patients with

low PCS scores

Objective/Aims:

• to identify themes regarding patient experience during single injection

nerve block placement with titrated sedation or enhanced

education/reassurance

• to explore the influence of pain catastrophizing on patient experience

Patients completed Pain Catastrophizing Scale questionnaire in pre-op

(PCS; range 0-52; low <10, high ≥10)

Patients randomized to receive moderate sedation or intraprocedural

education and reassurance.

Post-op semi-structured interviews about experience with single injection

nerve block (SINB) conducted;sample questions:

• If you were to describe your experience with the nerve block to

someone else, what would you say?

• What was your overall experience with having a nerve block? What do

you remember?

• Did you have a preference for the pharmacologic sedation or

nonpharmacologic reassurance/education group? If yes, which one?

Why?

Interviews audio-recorded + transcribed, dual coded inductively at the

semantic level (Dedoose Software) and iteratively categorized to identify

major themes

Demographics:

- Average age: 62 (SD:13.1)

- Average BMI : 31.2 (SD:6.4)

- 61% male

Professionalism and perceived

confidence; lack of pain 2/2 skill

and demeanor of providers

Therapeutic effect of

preprocedural description and

intraprocedural narration

Use of ultrasound :

engagement with procedure and

anesthesia team

perception of uncertainty

Welcome distraction + visual aid

Key Takeaways

1. Engagement with the anesthesia providers through intraprocedural education and narration with

ultrasound was engaging and distracting.

2. Patients with past painful procedural experiences and patients who endorsed avoidant coping strategies

appreciated the desired sedation effects of anxiolysis and analgesia.

3. PCS was not a clear defining factor in differences in patient experiences with receiving a single-injection

peripheral nerve block.

Large Block team sizes

Ambiguity of provider roles

patient anxiety

PCS did not appear to be a defining factor in patient

experiences with SINB, as similar themes occurred in patients

with a broad range of PCS scores.

Perceived therapeutic alliance with providers was a key

positive component of the patient experience. Patients valued

provider team who were friendly, confident, and

communicative.

Education and expectation setting, as well as narration

during ultrasound use, positively impacted the nerve block

experience, whereas large teams with unclear roles may

increase patient anxiety and lead to a more negative

experience.

Anxiety reduction and a focus on patient care delivery and

comfort are important

Connection with/qualities of the regional anesthesia provider or

team may be equally, or even more important, than what

intervention (sedation or education) during SINB