How UK obstetric anaesthetists test neuraxial anaesthesia: A comparison of OAA approved surveys in 2004 & 2010.
Abstract Number: F 8
Abstract Type: Other
Introduction: Neuraxial anaesthesia is the preferred mode of anaesthesia for caesarean delivery. As complications from neuraxial block are the predominant cause for complaint against anaesthetists , there is interest in the best method of assessing the adequacy of anaesthesia prior to caesarean delivery. Although cold sensation is commonly used, evidence suggests the risk of intra-operative pain may be reduced by assessment of light touch . We aimed to determine how neuraxial anaesthesia was being assessed, and whether changes in clinical practice reflected the differing evidence in the literature, over a six-year period.
Method: Both surveys were approved by the OAA Audit subcommittee (No. 42 & 106). The first survey was sent to UK consultant OAA members in 2004 asking how neuraxial anaesthesia was assessed prior to caesarean delivery, and what was documented. The survey was repeated in 2010.
Results: There was a response rate of 733/1045 (70%) and 549/1219 (45%) in 2004 and 2010, respectively.
The majority of anaesthetists tested more than one sensory modality in both surveys. The proportion of anaesthetists testing three modalities increased by 20% (95% CI 14-25, P < 0.0001). Cold was the most commonly used modality in both surveys. There was a trend towards increased assessment of light touch, and testing of motor blockade increased by 23% (95% CI 17-28, P < 0.0001). The number of anaesthetists checking pinprick fell by 20% (95% CI 14-25, P < 0.0001).
The upper level of anaesthesia accepted was dependent on the modality being tested. Testing to T4 with cold was the most common assessment in both surveys, and increased by 13% (95% CI 7-18, P < 0.0001) between surveys. There was also a increase in the testing of light touch to T5 by 18% (95% CI 11-25, P < 0.0001).
In both surveys, the extent of block to cold was the most commonly documented modality (81.9% & 90.0%). Documentation of light touch and motor block both increased (P < 0.0001).
Conclusions: Our surveys showed that methods of assessing neuraxial anaesthesia differed from those advocated in the literature. The wide range of modalities, methods of testing and targeted sensory levels suggests that clearer recommendations on best practice for assessment and documentation of neuraxial anaesthesia prior to caesarean delivery are required.
 Szypula K, Ashpole KJ, Bogod D, Yentis SM, Mihai R, Scott S, et al. Litigation related to regional anaesthesia: an analysis of claims against the NHS in England 1995-2007. Anaesthesia. 2010; 65: 443- 53
 Russell IF. Assessing the block for caesarean section. International Journal of Obstetric Anesthesia. 2001; 10 : 83-5