Wiercigroch David, Ben-Yakov Maxim, Porplycia Danielle, Friedman Steven Marc
Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
University Health Network, Department of Emergency Medicine, Toronto, ON, Canada.
CJEM. 2020 Jul;22(4):499-503. doi: 10.1017/cem.2020.51.
Regional anesthesia has many applications in the emergency department (ED). It has been shown to reduce general anesthetic dose, requirement for post-procedural opioids, and recovery time. We sought to characterize the use of regional anesthesia by Canadian emergency physicians, including practices, perspectives and barriers to use in the ED.
A cross-sectional survey was administered to members of the Canadian Association of Emergency Physicians (CAEP), consisting of sixteen multiple choice and numerical response questions. Responses were summarized descriptively as percentages and as the median and inter quartile range (IQR) for quantitative variables.
The survey was completed by 149/1144 staff emergency physicians, with a response rate of 13%. Respondents used regional anesthesia a median of 2 (IQR 0-4) times in the past ten shifts. The most broadly used applications were soft tissue repair (84.5% of respondents, n = 126), fracture pain management (79.2%, n = 118) and orthopedic reduction (72.5%, n = 108). Respondents agreed that regional anesthesia is safe to use in the ED (98.7%) and were interested in using it more frequently (78.5%). Almost all (98.0%) respondents had point of care ultrasound available, however less than half (49.0%) felt comfortable using it for RA. Respondents indicated that they required more training (76.5%), a departmental protocol (47.0%), and nursing assistance (30.2%) to increase their use of RA.
Canadian emergency physicians use regional anesthesia infrequently but express an interest in expanding their use. While equipment is available, additional training, protocols, and increased support from nursing staff are modifiable factors that could facilitate uptake.
区域麻醉在急诊科有多种应用。研究表明，它可减少全身麻醉剂量、术后阿片类药物的使用需求以及恢复时间。我们旨在描述加拿大急诊医生对区域麻醉的使用情况，包括在急诊科的实践、观点及使用障碍。
对加拿大急诊医师协会（CAEP）成员进行了一项横断面调查，问卷包含16个多项选择题和数值回答问题。回答以百分比形式进行描述性总结，并给出定量变量的中位数和四分位间距（IQR）。
1144名急诊医生中有149名完成了调查，回复率为13%。在过去十个轮班中，受访者使用区域麻醉的中位数为2次（IQR为0 - 4）。使用最广泛的应用是软组织修复（84.5%的受访者，n = 126）、骨折疼痛管理（79.2%，n = 118）和骨科复位（72.5%，n = 108）。受访者一致认为区域麻醉在急诊科使用是安全的（98.7%），并且有兴趣更频繁地使用它（78.5%）。几乎所有（98.0%）受访者都有即时超声设备，但不到一半（49.0%）的人对使用超声进行区域麻醉感到放心。受访者表示，他们需要更多培训（76.5%）、部门协议（47.0%）和护理协助（30.2%）来增加区域麻醉的使用。
加拿大急诊医生很少使用区域麻醉，但表示有兴趣扩大其使用。虽然设备已具备，但额外的培训、协议以及护理人员更多的支持是可以改变的因素，有助于推广区域麻醉的使用。
