Paediatric regional anaesthesia, a survey of practice in the United Kingdom

Abstract

Background: A variety of techniques and drugs, many unlicensed, is used in paediatric regional anaesthesia. This study is the first to survey paediatric anaesthetists about the techniques and drugs used in paediatric regional anaesthesia. The aim is to provide a record and benchmark of UK practice.

Methods: A postal questionnaire was sent to all members of the Association of Paediatric Anaesthetists residing in the UK. Information was requested on the type of hospital worked in, years of practice, paediatric anaesthesia workload, regional anaesthesia techniques used, and drugs used in regional anaesthesia.

Results: A total of 220 responses from 264 questionnaires (83.3%) were received. Of these respondents, 155 (70%) practised paediatric anaesthesia as more than 50% of their workload, and 10 had retired or returned blank forms. Two hundred and two of 210 (96%) use caudal anaesthesia and 151 (72%) use caudal, epidural and peripheral block. One hundred and ninety-two of 210 (91%) have no lower age limit for using caudal anaesthesia. One hundred and twenty-three of 210 anaesthetists (58%) used adjuvants with local anaesthetics in caudal block, the most common being fentanyl [44/210 (21%)], clonidine [55/210 (26%)], diamorphine [27/210 (13%)] and ketamine [67/210 (32%)]. Those working in specialist centres or teaching hospitals or who had a greater paediatric anaesthesia workload were more likely to use a greater variety of regional anaesthesia techniques.

Conclusions: Caudal anaesthesia is widely used for patients of all ages by almost all practitioners. Most anaesthetists at all hospital types and experience levels use adjuvants with local anaesthetics when performing caudal anaesthesia. Those with more experience in paediatric anaesthesia and those in specialist centres commonly use other neuraxial and peripheral block techniques.