ESRA19-0128 How good is your test: an audit on peripheral nerve block testing techniques

Background and aims The onset and extent of peripheral nerve blockade is tested prior to surgery in order to ascertain the success of blockade. The use of ultrasound to perform peripheral nerve blocks (PNBs) has become a standard procedure over the last few years. This audit was conducted at University Hospitals of Leicester NHS Trust to evaluate whether the use of ultrasound has made any impact on testing methods for PNBs. Methods A questionnaire circulated among anaesthetists analysed the indications and frequency of performing PNBs. Techniques used for assessing PNBs in awake/anaesthetised patients were evaluated. Surgeons’ technique of checking PNBs prior to incision was evaluated. Results Of the 47 responses collected, 70% were from consultant anaesthetists. Orthopaedic surgery was the main indication for nerve blocks (82.98%). For testing of PNBs, ethyl chloride spray was used by the majority (53.19%). The testing modalities used, and their prevalence is below. PNBs performed under general anaesthetic were assessed by a change in vital signs amongst 59.57% respondents. Surgeons were asked to check the block prior to incision by pinching the skin with toothed forceps (42.55%) and non-toothed forceps (8.51%). 36.17% respondents did not ask the surgeon to check the block prior to incision Conclusions Ethyl chloride spray remains the most commonly used technique for testing PNBs in awake patients followed by light touch and active limb movements. Surgeon’s test with toothed forceps is a good replication of both pressure and pain sensations. The current practice at UHL demonstrates a good understanding of how local anaesthetics effect different types of nerve fibres.