Henshaw Daryl S, Turner James D, Dobson Sean W, Douglas Jaffe Jonathan, Wells Reynolds John, Edwards Christopher J, Weller Robert S
Department of Anesthesiology, Section on Regional Anesthesia and Acute Pain Management, Wake Forest School of Medicine, Winston Salem, North Carolina, USA
Department of Anesthesiology, Section on Regional Anesthesia and Acute Pain Management, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
Reg Anesth Pain Med. 2019 Jan 13. doi: 10.1136/rapm-2018-000033.
The term "Wrong-Site Surgery (WSS)" is commonly associated with surgical procedures; however, The Joint Commission (TJC) considers any invasive procedure, not just a surgical procedure, performed on the wrong side, at the wrong site, or on the wrong patient to be a WSS. For anesthesia providers, this means that a wrong-site nerve block (WSNB) also constitutes a WSS and would be considered a sentinel event by TJC. In an attempt to combat WSNB, the American Society of Regional Anesthesia and Pain Medicine published guidelines in 2014 recommending the use of a preprocedural checklist before performing regional blocks. The effectiveness of such a checklist, however, to reduce the occurrence of WSNB has not yet been demonstrated. We hypothesized that the introduction of a preprocedural checklist specific for regional anesthesia would be associated with a lower rate of WSNB procedures.
A retrospective review was performed to compare the incidence of WSNB 2 years before, to 6 years after the implementation of a preprocedural checklist specific to regional anesthesia.
Prior to checklist implementation, 4 WSNB events occurred during 10 123 procedures (3.95 per 10 000 (95% CI 1.26 to 9.53). Following implementation, WSNB events occurred during 35 890 procedures (0 per 10 000 (95% CI 0 to 0.84)); p=0.0023.
Implementation of a regional anesthesia specific preprocedural checklist was associated with a significantly lower incidence of WSNB procedures. While prospective controlled studies would be required to demonstrate causation, this study suggests that for regional anesthesia procedures, a preprocedural checklist may positively impact patient safety.
“手术部位错误（WSS）”一词通常与外科手术相关；然而，联合委员会（TJC）认为，任何侵入性操作，不仅是外科手术，在错误的一侧、错误的部位或对错误的患者进行操作都属于手术部位错误。对于麻醉提供者而言，这意味着错误部位神经阻滞（WSNB）也构成手术部位错误，并且会被TJC视为警讯事件。为了应对WSNB，美国区域麻醉与疼痛医学学会在2014年发布了指南，建议在进行区域阻滞前使用术前检查表。然而，这种检查表在降低WSNB发生率方面的有效性尚未得到证实。我们假设引入专门针对区域麻醉的术前检查表会使WSNB操作的发生率降低。
进行回顾性研究，比较实施专门针对区域麻醉的术前检查表之前2年与之后6年WSNB的发生率。
在检查表实施之前，10123例手术中有4例发生WSNB事件（每10000例中有3.95例（95%可信区间1.26至9.53））。实施之后，35890例手术中有WSNB事件发生（每10000例中有0例（95%可信区间0至0.84））；p = 0.0023。
实施专门针对区域麻醉的术前检查表与WSNB操作的发生率显著降低相关。虽然需要前瞻性对照研究来证明因果关系，但本研究表明，对于区域麻醉操作，术前检查表可能会对患者安全产生积极影响。
