Regionalna anestezja w Polsce w 2002 roku

Tomasz Siegel, Ewa Mayzner-Zawadzka

Summary
Background. As in previous years, a questionnaire was sent to hospitals all over the country. The main goal of the survey was to acquire information regarding the use of various regional techniques and equipment. Methods. The questionnaire was sent to 571 hospitals of different level. Information was sought on the number of surgical procedures performed under regional anaesthesia (RA), the choice of equipment and drugs, and complication rates. Particular information was sought on the use of RA for obstetrics, intensive care and postoperative pain. Data were compared with that obtained in a previous survey to determine if there was any change over years 1996 – 2002. Results. The questionnaire was returned by 190 hospitals; 6 did not provide adequate data. Analysis was therefore performed on only 184 hospitals (33.3% return). They comprised 112 regional, 8 private, 48 district and specialized, and 16 university hospitals, in which 498 321 various surgical procedures were performed during the year 2002. The percentage of procedures performed under RA was 31.5% (32.4%, 32.5% and 26.7% in regional, district and university hospitals, respectively). The most common techniques were: subarachnoid analgesia (SA), epidural analgesia (EP) at various levels, brachial plexus blocks (BP) and combined anaesthesia (RA + general). There was a notable tendency in university hospitals to replace SA with EP and/or combined spinal-epidural analgesia (CSE). RA was used for postoperative pain control in 91% of analyzed hospitals, mostly with the use of EP. In the majority of hospitals, 25/26G Pencil Point (72%) and Quincke (69%) needles were used for SA. In 28.5%, 22G needles were still used. Bupivacaine was used in 99% of hospitals for SA and in 91% for EP. Simultaneously, 46% and 52% of hospitals were using lidocaine for shorter procedures. Ropivacaine was used in 4 hospitals only. Neuraxial opioids were used in 56% of SA and 91% of EP. Fourteen serious complications of SA (total spinal blocks, toxic reactions, cardiac arrests) were reported (1.3:10,000). Post-dural puncture headaches were noted in 1.7% of all SA; 6% of those required a blood patch. Twelve serious complications of EP (total spinal block, respiratory distress, toxic reactions and epidural haematoma) were reported (6.8:10,000). Among twelve complications of peripheral blocks (incidence 6.3:10,000) were: toxic reactions (6), total spinal block following brachial plexus block (2), pneumothorax (2), persistent paraesthesias (1) and axillary fossa haematoma (1). RA for delivery (mostly EP) was provided in 4.6% of cases, mostly in university hospitals. 69.2% of caesarean sections were performed under RA (88.1% SA, 10.9% EP and 1.1% CSE). Regional techniques were used in 10.5% of ICU patients, mostly for acute pancreatitis, postoperative pain control and local ischaemic episodes. Discussion. The percentage of surgical procedures performed under RA was 31.5%, which represents an increase, compared to the 1996 and 1998 surveys (26.8% and 28.9%, respectively). There was a marked increase in the frequency of SA (70.8%, compared to 57.0% and 59%). New techniques, e.g. CSE, peripheral blocks and new drugs were not widely used. EP was limited mostly to the lumbar approach. Surprisingly, a large number of centres (28.5%) were still using large bore needles for SA. The number of caesarean sections performed under RA increased, compared with previous years. The number is significantly lower than in France, UK or Switzerland, but higher than in Germany. Data concerning complications, although valuable, have not been reliable due to the lack of a national reporting system. Conclusions. We conclude that the proportion of surgical procedures performed under RA in Poland is similar to that in other countries, with spinal anaesthesia being the most common procedure. RA is used more often and in wider range of techniques in high-level hospitals. There has been a tendency to more frequent use of RA in obstetrics.

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