SWARM Perioperative Regional Anaesthetic Techniques Survey SPRATS Lead Investigators Dr T Wilson and Dr M Rockett
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
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
Method Inclusion Criteria Any surgery involving abdominal wall incision Exclusion Criteria Under 16 Inguinal hernia repairs Obstetrics Laparoscopic Surgery (not lap assisted)
Method Denominator data was collected retrospectively by reviewing theatre lists at each individual trusts
Results 84% overall pick up rate 190 patient events 207 blocks performed
Results Large amount of data Analysed by: Surgery Trust Incision Urgency
Pick up rate by Trust and overall 100 90 80 70 60 50 40 30 20 10 0 Truro Derriford NDDH RDE Musgrove Torbay Total
Complete Data Number % Total occurred 227.0 Number collected 191.0 84.1% Age (yrs) 61.4 Age Confidence interval +/-2.4 Weight (kg) 78.5 Weight Confidence interval +/-2.5 Male 97.0 51.3% Female 92.0 48.7% ASA 1 22.0 11.5% ASA 2 99.0 51.8% ASA 3 58.0 30.4% ASA 4 11.0 5.8% ASA 5 0.0 0.0% Daycase 3.0 1.6% Scheduled 125.0 65.4% Emergency 62.0 32.5% General 145.0 75.9% Urology 21.0 11.0% Gynaecology 24.0 12.6% Rectus sheath 47.8 24.8% TAP 28.5 14.8% Wound 47.8 24.8% Spinal 22.6 11.8% Epidural 45.9 23.8% catheter 57.0 44.2% single 72.0 55.8% Intermittent Boluses 23.0 43.4% Constant Infusion 30.0 56.6% Surgeon 90.0 72.0% Anaesthetist 35.0 28.0% Ultrasound used 32.0 91.4% Patient Controlled Analgesia 76.0 39.8%
SURGERY AND INCISION
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%
% Incision by Speciality 50 45 40 35 30 25 20 Pfannensteil Midline infra-umbilical Midline Supra umbilical Midline Subcostal Oblique Loin inguinal 15 10 5 0 General Gynaecology Urology
Technique by Surgery 40 35 30 25 20 15 Rectus sheath TAP Subcostal Tap Wound epidural Spinal and other Spinal only 10 5 0 Count % Count % Count % General Urology Gynae
% Technique by incision 100 90 80 70 60 50 40 30 Rectus sheath TAP Subcostal Tap Wound epidural spinal and other spinal only 20 10 0 Inguinal Loin Subcostal Oblique Supra umbilical and midline Midline infra Pfaninsteal
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
TRUST VARIATION
% ASA by Trust 60 50 40 30 Overall Barnstaple Taunton Exeter Torbay Truro Plymouth 20 10 0 1 2 3 4 5 ASA
Rectus sheath TAP Wound Spinal Epidural
Royal Devon and Exter Number % Foundation Trust Total occurred 46.0 Number collected 43.0 93.5% Age (yrs) 64.5 Age Confidence interval 5.1 Weight (kg) 76.4 Weight Confidence interval 5.1 Male 29.0 67.4% Female 14.0 32.6% ASA 1 6.0 14.0% ASA 2 24.0 55.8% ASA 3 11.0 25.6% ASA 4 2.0 4.7% ASA 5 0.0 0.0% Rectus sheath TAP Wound Spinal Epidural Daycase 2.0 4.7% Scheduled 30.0 69.8% Emergency 11.0 25.6% General 34.0 79.1% Urology 7.0 16.3% Gynaecology 2.0 4.7% Rectus sheath 20.0 50.2% TAP 0.0 0.0% Wound 9.0 22.6% Spinal 0.8 2.0% Epidural 10.0 25.1% catheter 22.0 66.7% single 11.0 33.3% Intermittent Boluses 18.0 100.0% Constant Infusion 0.0 0.0% Surgeon 25.0 86.2% Anaesthetist 4.0 13.8% Ultrasound used 4.0 100.0% Patient Controlled Analgesia 14.0 32.6%
Rectus sheath TAP Wound Spinal Epidural
Rectus sheath TAP Wound Spinal Epidural Royal Cornwall Hospital Numbers % Total occurred 23.0 Number collected 22.0 95.7% Age (yrs) 60.5 Age Confidence interval 8.4 Weight (kg) 84.5 Weight Confidence interval 9.2 Male 10.0 45.5% Female 12.0 54.5% ASA 1 3.0 13.6% ASA 2 6.0 27.3% ASA 3 12.0 54.5% ASA 4 1.0 4.5% ASA 5 0.0 0.0% Daycase 0.0 0.0% Scheduled 10.0 45.5% Emergency 12.0 54.5% General 18.0 81.8% Urology 0.0 0.0% Gynaecology 4.0 18.2% Rectus sheath 5.0 21.8% TAP 2.0 8.5% Wound 3.0 13.1% Spinal 6.0 26.1% Epidural 7.0 30.5% catheter 3.0 25.0% single 9.0 75.0% Intermittent Boluses 0.0 0.0% Constant Infusion 3.0 100.0% Surgeon 8.0 72.7% Anaesthetist 3.0 27.3% Ultrasound used 3.0 100.0% Patient Controlled Analgesia 8.0 36.4%
Rectus sheath TAP Wound Spinal Epidural
Rectus sheath TAP Wound Spinal Epidural
DATA BY TECHNIQUE
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
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