Australian and New Zealand Registry of Regional Anaesthesia (AURORA)

Transcription

1 Australian and New Zealand Registry of Regional Anaesthesia (AURORA) Overview of Results First 4000 procedures recorded to - June 1st 2011 to February 2012

2 Background Australian and New Zealand Registry of Regional Anaesthesia (AURORA) Objective: Determine the Quality and Safety of Peripheral Regional Anaesthesia Registry methodology - captures native clinical behaviour Web interface: Blog:

3 Clinical registries Complete inclusion of all eligible patients Capture ALL episodes of peripheral regional anaesthesia performed by ALL practitioners on ALL patients Reduce selection bias

4 Patient characteristics Characteristic Age (yr, mean ± SD) 58 ±19 Weight (kg, mean ± SD) 80 ± 19 Height (m, mean ± SD) 1.68 Gender (M/F), % 49/51 ASA status (I/II/III/IV), % 20/39/36/5 Diabetes, % 17

5 Patient and practice characteristics Characteristic % Cancer 6 Emergency 27 After Hours 13 Chronic analgesic use 18 Neurological disease 10

6 Chronic analgesis use Chronic analgesia n(%) No 2544 (82) Regular panadeine forte or similar Regular oxydodone, opioid patches or similar 175 (6) 290 (9.4) Antineuropathic drugs 63 (2) Advanced therapy (pain pump) 11(0.3)

7 Neurological disease Neurological disease n(%) Peripheral neuropathy 73 (2.4) Diabetic neuropathy 112 (3.6) Demyelinating disease, Carpal tunnel syndrome, Ulnar neuritis 13 (0.3)

8 Neurological disease Neurological disease n(%) CVA with deficit 26 (0.8) Post-surgical/traumatic 112 (0.9) Spinal stenosis, Disc herneation, compressive radiculopathy 21 (1) Other 91 (2.9) Multiple diagnoses 10 (0.3) None 2780 (90)

9 Types of surgery Shoulder, proximal, humerus, clavicle Humerus, elbow Forearm, hand, wrist Thorax Abdomen Hip Femur, thigh Knee Leg Ankle Neck Not assoc. with surgery 25% 4% 10% 1%0% 4% 9% 11% 4% 17% 2% 13%

10 Block type (category) Interscalene Supraclavicular Infraclavicular % Axillary Paravertebral Trunk Femoral Sciatic L.L./U.L. other

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12 Timing n (%) Preoperatively 3160 (79) In immediate postoperative period 769 (19) In postoperative period after departing PACU 23 (0.5) Unrelated to surgery 29 (0.7)

13 Block purpose n (%) Intraoperative anaesthesia 123 (3) Postoperative analgesia 2311 (58) Both Anaesthesia and analgesia 1466 (37) Postoperative analgesia inserted postoperatively 33 (0.8) Analgesia unrelated to surgery 25 (0.6) Rescue block 22 (0.5) Chronic pain 3 (0.08)

14 Block category-femoral Operative region FNB % Fascia iliaca % Total, n Hip joint, neck of femur Femur and thigh Knee and popliteal region Leg (below knee, above ankle) Ankle foot/toes Unrelated to surgery 100 2

15 Block category-trunk Operative region = Abdominal cavity and wall Block type n (%) Transversus abdominis plane - posterior 465 (72) Transversus abdominis plane - subcostal 100 (15) Ilioinguinal/iliohypogastric 60 (9) Rectus sheath 20 (3) Genitofemoral 3 (0.4) Intercostal 1 (0.1)

16 Block category-paravertebral Operative region Total, n (%) Neck 2 (0.9) Abdominal wall 16 (7) Hip joint, neck of femur 135 (58) Femur and thigh 12 (5) Knee and popliteal region 6 (3) Thorax 60 (26)

17 % 13% 7% 6% 30% 28% 59% 50% Ultrasound alone Ultrasound and Nerve stimulator Nerve stimulator (alone) Landmark Technology used to located nerves

18 Single-shot or catheter Single-shot Catheter (Non-stimulating) Stimulating Catheter 2% 22% 76%

19 Catheter by block category 50 Catheter as % of block type/category ISB SCB ICB AX PVB Trunk Femoral Sciatic

20 Barrier protection Sterile Gloves Gown, gloves and mask Non-sterile gloves 20% 12% 68% If no catheter used

21 Barrier protection Sterile Gloves Gown, gloves and mask Non-sterile gloves 1% 15% 84% If catheter technique used

22 Probe cover Sterile probe cover Simple dressing (e.g. Tegaderm) None 10% 18% 72% as a % of procedures performed with ultrasound

23 Probe cover Sterile probe cover Simple dressing (e.g. Tegaderm) None 0% 3% 97% as a % of catheter techniques performed with ultrasound

24 Level of sedation (during block insertion) 24% 21% 4% Alert and Awake Light sedation Moderate sedation Unresponsive to noxious stimuli 51%

25 Level of sedation (as function of block category) 80 % Block category BP Paravert. Trunk Lower Limb BP = brachial plexus

26 Level of sedation Block category = Femoral 60 % Femoral 1, Alert 2, Light sedation 3, Moderate sedation 4, Unresponsive

27 Blocks performed with patent unresponsive as a 70 function of hospital/practice % Blocks unresponsive Hosp ID

28 Local anaesthetic Ropivacaine Lignocaine Bupivacaine Levobupivacaine 8% 4% 4% 85%

29 Local anaesthetic dosage (ropivacaine), mg/kg Period Mean (SD) ± ± ± 0.7 dosage for single blocks only

30 Success of block 13% 3% 1% 30% Successful Successful-GA other Successful-Neuraxial other Incomplete block failure Failure 53%

31 Immediate Complications Immediate complications Major Local Anaesthetic toxicity 2 Puncture of major artery or vein 18 Haematoma 7 Respiratory depression arrest 1 Unintended paraesthesia 41 Horner s syndrome 2 Intraneural injection 3 Unintentional removal of catheter 3 Wrong site block 1 First 4000 procedures - June 1st 2011 to February 23rd 2012 n

32 PACU analgesia type Analgesia type % None 60 IV Opioid 19 Oral opioids 2 Paracetamol 5 Tramadol 1 LA bolus 2 Repeat block 0.7 Preemptive 4 Outside surgical area 1 results from one hospital only

33 Day 1 complications Day1 Complications Block failure requiring opioids 64 Unintentional removal of catheter 9 Readmission for poor pain relief 2 Haematoma 5 Motor block impairing mobilisation 33 Technical problem, kink, leak, disconnection 33 Pain, bruising at site 24 Horner s syndrome 4 None 2719 First 4000 procedures - June 1st 2011 to February 23rd 2012 n

34 Patient-rated outcomes Completely dissatisfied Dissatisfied Not satisfied, nor dissatisfied Satisfied Completely satisfied Unable to answer Hospital with high followup 15% 2% 1% 1% 17% Potential sample = (83%) completed Responses (%) based on completed questionnaires 64% Q 1. To what degree were you satisfied about the explanation of the regional anaesthesia (nerve block) procedure?

35 Patient-rated outcomes Completely dissatisfied Dissatisfied Not satisfied, nor dissatisfied Satisfied Completely satisfied Unable to answer Hospital with high followup 15% 2%2% 18% Potential sample = (83%) completed Responses (%) based on completed questionnaires 63% Q 2. To what degree were you satisfied about the amount of information about the regional anaesthesia (nerve block) procedure?

36 Patient-rated outcomes None Mild - barely noticeable Moderate - definitely noticeable Severe - very preoccupied by the symptom Unable to answer Potential sample = (84%) completed Responses (%) based on completed questionnaires Hospital with high followup 4% 6% 25% 12% 53% Q 3. To what degree did you experience pain during the regional anaesthesia (nerve block) procedure?

37 Patient-rated outcomes None Mild - barely noticeable Moderate - definitely noticeable Severe - very preoccupied by the symptom Unable to answer Hospital with high followup 10% 4% Potential sample = (84%) completed Responses (%) based on completed questionnaires 20% 33% 34% Q 4. To what degree did you after the operation have pain?

38 Patient-rated outcomes None Mild - barely noticeable Moderate - definitely noticeable Severe - very preoccupied by the symptom Unable to answer Hospital with high followup 12% 5%0%2% Potential sample = (84%) completed Responses (%) based on completed questionnaires 80% Q 5. To what degree did you after the operation have vomiting?

39 Patient-rated outcomes None Mild - barely noticeable Moderate - definitely noticeable Severe - very preoccupied by the symptom Unable to answer Hospital with high followup 4% 4% 11% Potential sample = (84%) completed Responses (%) based on completed questionnaires 26% 54% Q 6. To what degree after the operation, did numbness or heavine of the anaesthetised limb or body part bother you?

40 Patient-rated outcomes None Mild - barely noticeable Moderate - definitely noticeable Severe - very preoccupied by the symptom Unable to answer Hospital with high followup 17% 7% 19% Potential sample = (84%) completed Responses (%) based on completed questionnaires 19% 37% Q 7. When the numbness/heaviness related to the nerve block wore off, how much pain did you experience?

41 Patient-rated outcomes None Mild - barely noticeable Moderate - definitely noticeable Severe - very preoccupied by the symptom Unable to answer Hospital with lower followup 19% 7% rate 13% Potential sample = (41%) completed Responses (%) based on completed questionnaires 26% 35% Q 7. When the numbness/heaviness related to the nerve block wore off, how much pain did you experience?

42 Patient-rated outcomes Completely dissatisfied Dissatisfied Not satisfied, nor dissatisfied Satisfied Completely satisfied Unable to answer Hospital with high followup 12% 1%1% 21% Potential sample = (84%) completed Responses (%) based on completed questionnaires 64% Q 8. To what degree did your anaesthetist show undestanding for your situation?

43 Patient-rated outcomes Completely dissatisfied Dissatisfied Not satisfied, nor dissatisfied Satisfied Completely satisfied Unable to answer Hospital with high followup 15% 1%1% 17% Potential sample = (84%) completed Responses (%) based on completed questionnaires 66% Q 9. To what degree did your anaesthetist pay attention to complaints like pain and discomfort?

44 Patient-rated outcomes Completely dissatisfied Dissatisfied Not satisfied, nor dissatisfied Satisfied Completely satisfied Unable to answer Hospital with high followup 15% 1% 17% Potential sample = (84%) completed Responses (%) based on completed questionnaires 67% Q 10. To what degree did your anaesthetist pay attention to your questions?

45 Patient-rated outcomes Yes Unable to answer No Hospital with high followup 7% 10% Potential sample = (86%) completed Responses (%) based on completed questionnaires 83% Repeat OK. Were you to require a similar operation again, would you be happy to have the same type of a regional anaesthetic again?

46 Follow-up methods Phone History review Letter Ward visit Clinic visit 18% 3% 2% 2% 74%

47 Follow-up rates Successful Dementia Deceased Language Other Unsure 1% 2% 1% 0% 5% 91%

48 Pain at Delayed Followup 15% 2% None Mild - barely noticable Moderate - definitely noticable Severe -definitely preoccupied by the symptom 37% 45%

49 Delayed Complications n Neuropathy consistent with nerve/plexus blockde 3 Postoperative neurological symptom 131 Pain/bruising at injection site 37 Infection 13 Specific mononeuropathy 3 Neurology outside the nerve/plexus region 14 Postoperative neuropathy unrelated to RA 15 Neurology (surgery) 80 None 2581 First 4000 procedures - June 1st 2011 to February 23rd 2012

50 End of AURORA overview