SWARM Perioperative Regional Anaesthetic Techniques Survey SPRATS. Lead Investigators Dr T Wilson and Dr M Rockett

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1 SWARM Perioperative Regional Anaesthetic Techniques Survey SPRATS Lead Investigators Dr T Wilson and Dr M Rockett

2 Sprats 2 week service evaluation of regional and local anaesthetic techniques used for surgery involving abdominal wall incision The 6 Trusts of South West Peninsula

3 Method The project was registered as service evaluation or audit at each site A pilot day was performed in the majority of Trusts. Data was collected by local trainees and research nurses Data was collected in theatre and in recovery rooms. Standardised data collection form throughout South west Data was transferred onto a Central electronic database for analysis by Excel

4 Method Inclusion Criteria Any surgery involving abdominal wall incision Exclusion Criteria Under 16 Inguinal hernia repairs Obstetrics Laparoscopic Surgery (not lap assisted)

5 Method Denominator data was collected retrospectively by reviewing theatre lists at each individual trusts

6 Results 84% overall pick up rate 190 patient events 207 blocks performed

7 Results Large amount of data Analysed by: Surgery Trust Incision Urgency

8 Pick up rate by Trust and overall Truro Derriford NDDH RDE Musgrove Torbay Total

9 Complete Data Number % Total occurred Number collected % Age (yrs) 61.4 Age Confidence interval +/-2.4 Weight (kg) 78.5 Weight Confidence interval +/-2.5 Male % Female % ASA % ASA % ASA % ASA % ASA % Daycase % Scheduled % Emergency % General % Urology % Gynaecology % Rectus sheath % TAP % Wound % Spinal % Epidural % catheter % single % Intermittent Boluses % Constant Infusion % Surgeon % Anaesthetist % Ultrasound used % Patient Controlled Analgesia %

10 SURGERY AND INCISION

11 Incisions used in the Peninsular Area for Abdominal surgery inguinal 10% Pfannensteil 11% Loin 6% Subcostal Oblique 9% Midline infra-umbilical 16% Midline Supra umbilical 9% Midline 39%

12 % Incision by Speciality Pfannensteil Midline infra-umbilical Midline Supra umbilical Midline Subcostal Oblique Loin inguinal General Gynaecology Urology

13 Technique by Surgery Rectus sheath TAP Subcostal Tap Wound epidural Spinal and other Spinal only Count % Count % Count % General Urology Gynae

14 % Technique by incision Rectus sheath TAP Subcostal Tap Wound epidural spinal and other spinal only Inguinal Loin Subcostal Oblique Supra umbilical and midline Midline infra Pfaninsteal

15 Emergency vs Elective Laparotomy 35% 30% 25% 20% 15% emergency scheduled 10% 5% 0% Epidural Rectus Sheath TAP Subcostal tap Wound Spinal Rectus and Spinal Wound and Spinal Combined Spinal and Epidural ICU Sedated without LA

16 TRUST VARIATION

17 % ASA by Trust Overall Barnstaple Taunton Exeter Torbay Truro Plymouth ASA

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19 Rectus sheath TAP Wound Spinal Epidural

20 Royal Devon and Exter Number % Foundation Trust Total occurred 46.0 Number collected % Age (yrs) 64.5 Age Confidence interval 5.1 Weight (kg) 76.4 Weight Confidence interval 5.1 Male % Female % ASA % ASA % ASA % ASA % ASA % Rectus sheath TAP Wound Spinal Epidural Daycase % Scheduled % Emergency % General % Urology % Gynaecology % Rectus sheath % TAP % Wound % Spinal % Epidural % catheter % single % Intermittent Boluses % Constant Infusion % Surgeon % Anaesthetist % Ultrasound used % Patient Controlled Analgesia %

21 Rectus sheath TAP Wound Spinal Epidural

22 Rectus sheath TAP Wound Spinal Epidural Royal Cornwall Hospital Numbers % Total occurred 23.0 Number collected % Age (yrs) 60.5 Age Confidence interval 8.4 Weight (kg) 84.5 Weight Confidence interval 9.2 Male % Female % ASA % ASA % ASA % ASA % ASA % Daycase % Scheduled % Emergency % General % Urology % Gynaecology % Rectus sheath % TAP % Wound % Spinal % Epidural % catheter % single % Intermittent Boluses % Constant Infusion % Surgeon % Anaesthetist % Ultrasound used % Patient Controlled Analgesia %

23 Rectus sheath TAP Wound Spinal Epidural

24 Rectus sheath TAP Wound Spinal Epidural

25 DATA BY TECHNIQUE

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27 Discussion There is quite marked variation in practice across the south west Epidurals have been partially taken over by other techniques PCA usage is high in non epidural techniques and often combined with catheter infusions Surgeons do the majority

28 SWARM SWARM has been able to perform another multi-centred service evaluation project with an excellent pick up rate. The project highlights difference in practice lack of evidence We hope to go on to use the one to improve the latter