NYSORA - The New York School of Regional Anesthesia: Regional Anesthesia in the United States: The Use of Peripheral Nerve Blocks in the USA

Regional Anesthesia in the United States: The Use of Peripheral Nerve Blocks in
the USA
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JNYSORA Volume 10 March 2009
The results of this survey point out that the American Society of Regional
Anesthesia (ASRA) and its membership are significant promoters of the regional
anesthesia and peripheral nerve blocks.
Based on: "Hadzic A, Vloka JD, Kuroda MM, Koorn R, Birnbach DJ. The use of
peripheral nerve blocks in anesthesia practice. A national survey. Reg Anesth
Pain Med 1998:23:241-246".
In an attempt to ascertain clinical practice paterns and use of peripheral
nerve blocks, we surveyed 805 randomly selected U.S. anesthesiologists.[1]
Responses from 409 attending anesthesiologists (response rate 56.5%) revealed
that while almost all of them (97.8%) regularly use at least some regional
anesthesia techniques in their practice, significantly fewer use peripheral
nerve blocks. Most anesthesiologists (59.7%) perform less than five peripheral
nerve blocks a month. Peripheral nerve blocks of the lower extremity (femoral
32%, sciatic 22%, popliteal 11%) were less frequently used than peripheral nerve
blocks of the upper extremity (axillary 88%, interscalene 61%; p
Figure 2: Horizontal bars represent percentage of anesthesiologists who use the
technique in their ambulatory anesthesia practice.
* Hadzic A, Vloka JD, Koorn R, Sanborn K, Shih H, Birnbach DJ. The use of
regional anesthesia in ambulatory anesthesia practice. Results of a national
survey. Anesthesiology 1997; 3A:A22.
The results of this survey point out that the American Society of Regional
Anesthesia (ASRA) and its membership are significant promoters of the regional
anesthesia and peripheral nerve blocks. This is clearly reflected in the fact
that the members of ASRA not only practice significantly more peripheral nerve
blocks than anesthesiologists who are not ASRA members, but they also perform
technically more challenging peripheral nerve blocks (e.g. lower extremity
blocks). Another indirect indication of their enthusiasm for regional anesthesia
is reflected in their overall high response rate to this survey.
Of note, despite the apparent underutilization of lower extremity peripheral
nerve blocks, many practitioners expected that peripheral nerve blocks will have
an increased role in their clinical practice in the future. Since the infrequent
use of peripheral nerve blocks makes it difficult to achieve time-efficient
proficiency in these techniques in a fast-paced environment, it is important
that organized anesthesia societies, such as ASA, ASRA, and SAMBA continue to
offer hands-on regional anesthesia workshops as well as symposia that also focus
on less frequently used PNB techniques. Finally, education of our patients and
surgical colleagues as to the advantages of peripheral nerve blocks, and
elimination of all logistical problems that impede the easy placement of
regional blocks and patient flow are equally important.
REFERENCES:
1.
Hadzic A,Vloka JD, Kuroda MM, Koorn R, Birnbach DJ. The use of peripheral nerve
blocks in anesthesia practice. A national survey. Reg Anesth Pain Med
1998:23:241-246.
2.
Vloka JD, Hadzic A, Mulcare R, Lesser JB, Kitain E, Thys DM. Femoral nerve
block versus spinal anesthesia for outpatients undergoing long saphenous vein
stripping surgery. Anesth Analg,1997;84:749-52.
3.
Vloka JD, Hadzic A, Mulcare R, Lesser JB, Koorn R, Thys DM. Combined blocks of
the sciatic nerve at the popliteal fossa and posterior cutaneous nerve of the
thigh for short saphenous vein stripping in outpatients: An alternative to
spinal anesthesia. J Clin Anesth 1997;9:618-22.