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FOLLOW-UP REVIEW OF NON-PHYSICIAN DELIVERED UPPER LIMB LOCAL ANAESTHETIC NERVE BLOCKS AT A TERTIARY REFERRAL HAND CENTRE
ESRA Academy. Prins N. Sep 8, 2016; 138342
Topic: Upper Limb Blocks - Brachial Plexus Block
Mr. Niko Prins
Mr. Niko Prins

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Abstract
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Background and Aims:

The Birmingham Hand Centre at the Queen Elizabeth Hospital Birmingham (QEHB) provides trauma and elective tertiary hand services for the West Midlands, undertaking approximately 3500 operative procedures each year. The regional block service has developed alongside the hand service and the Physicians’ Assistant (Anaesthesia) (PA(A)) role has become integral to the delivery of an efficient service.

The aim of the review is to demonstrate that Physicians’ Assistants (Anaesthesia) continue to provide an effective service in ultrasound-guided upper limb regional anaesthesia.

Methods:

Upper limb nerve blocks at the Birmingham Hand Centre are performed under ultrasound guidance along with nerve stimulation.
PA(A)s, trainee anaesthetists and most consultant anaesthetists use a 50:50 mix of 0.75% ropivacaine and 2% lignocaine with 1:200.000 adrenaline as the local anaesthetic agent.
Investigation examined the number of blocks according to grade, top-up rates and volumes of local anaesthetic used.

Results:

2510 upper limb axillary brachial plexus blocks were recorded between January 2015 and April 2016, with the majority of these performed by PA(A)s (60%).
Top-up rates by grade were similar for consultants (3%) and PA(A)s (3.5%), but increased to 6.5% for trainees.
The median local anaesthetic volume administered for the primary block is similar between consultants (25ml), PA(A)s (25ml) and trainees (26ml).

Conclusions:

Preliminary results show that PA(A)s continue to provide an effective axillary brachial plexus anaesthetic block service, with similar primary success rates to consultant anaesthetists. Total volumes of local anaesthetic for primary blocks are similar across all groups but trainees administer a higher total volume due to the increased top-up requirements.

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