Kutschke N, Lampe J, Hoepfner O, Kitara D L, Schuster A
Werner Forßmann Klinikum, Akademisches Lehrkrankenhaus der Charité, Klinik für Anästhesie und Intensivmedizin, Eberswalde, Germany.
Charité - University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
Hum Resour Health. 2025 Apr 14;23(1):19. doi: 10.1186/s12960-025-00987-4.
Hospitals such as the Gulu Regional Referral Hospital (GRRH) in northern Uganda, like many other regions of sub-Saharan Africa, lack the anaesthetists needed to provide adequate analgesia during surgical procedures. The GRRH has not employed any anaesthesiologist for many years. Instead, anaesthesia is carried out by non-physician anaesthetic officers (AO) and other healthcare workers (HWs). In this setting, peripheral regional anaesthesia (pRA) is a safe and resource-efficient alternative that HWs and AOs could use. The study aimed to evaluate surgical procedures, anaesthetic practices, and staffing at Gulu Regional Referral Hospital in Northern Uganda. The objective was to identify the appropriate audience for pRA training and the corresponding training content.
A retrospective review was conducted on surgical procedures and their anaesthetic management in three departments of GRRH during 2019. The possibility of performing pRA was determined based on the surgical site, infection status, and the type of surgical procedure being performed. A pRA was considered adequate when conditions for pRA were met and pRA was carried out. Chi-square test was used to compare categorical data. A bivariable logistic regression analysis was performed to identify the factors associated with the administration of peripheral regional anaesthesia and the qualifications of medical staff.
A total of 804 procedures were recorded [67% in accident and emergency (A&E), 31% in operating room (OR), and 2% on the surgical ward]. Anaesthesia was recorded in 82% of cases. Of these, 86% were documented in regional and local anaesthesia. Anaesthetic officers carried out anaesthesia in 20% of all cases and in all cases in the operating room. HWs with more than 2 years of training performed adequate pRA more frequently than HWs with less than 1 year of experience [Odds ratio (OR) = 2.586; 95% CI 1.336-5.005; p = 0.005]. The last group, however, performed significantly more procedures in A&E than in other departments (89%, p < 0.001). Of the 209 procedures that could have been performed with pRA, 85 were found to be inadequately anaesthetised. 79% (67) of these were performed in the emergency department. In 45% of cases with inadequate anaesthesia, patients received local anaesthesia instead of appropriate pRA. Pain control was absent in 18% of cases, and 20% of cases received presumably unnecessary general anaesthesia or sedation. In 17% of cases, additional administration of ketamine and/or midazolam was required due to insufficient pRA.
The data show that pRA procedures are already used at GRRH, especially by HWs with high level of training in the OR. In A&E, which is primarily staffed by doctors with less than 1-year training, there is a potential to increase the administration of adequate pain relief by implementing simple nerve blocks into routine clinical practice. Therefore, doctors and staff in A&E would benefit from needs-based training in pRA.
与撒哈拉以南非洲的许多其他地区一样，乌干达北部的古卢地区转诊医院（GRRH）等医院缺乏在外科手术期间提供充分镇痛所需的麻醉医生。GRRH已经多年没有雇佣任何麻醉医生了。相反，麻醉由非医生麻醉人员（AO）和其他医护人员（HW）进行。在这种情况下，外周区域麻醉（pRA）是HW和AO可以使用的一种安全且资源高效的替代方法。该研究旨在评估乌干达北部古卢地区转诊医院的外科手术、麻醉实践和人员配备情况。目的是确定pRA培训的合适受众以及相应的培训内容。
对GRRH三个科室2019年的外科手术及其麻醉管理进行回顾性研究。根据手术部位、感染状况和所进行的外科手术类型确定进行pRA的可能性。当满足pRA条件并进行了pRA时，则认为pRA是充分的。采用卡方检验比较分类数据。进行双变量逻辑回归分析以确定与外周区域麻醉给药和医务人员资质相关的因素。
共记录了804例手术[67%在急诊（A&E），31%在手术室（OR），2%在外科病房]。82%的病例记录了麻醉情况。其中，86%记录为区域和局部麻醉。AO在所有病例的20%以及手术室的所有病例中实施麻醉。接受过2年以上培训的HW比经验不足1年的HW更频繁地进行充分的pRA[优势比（OR）=2.586；95%置信区间1.336 - 5.005；p = 0.005]。然而，后一组在急诊进行的手术明显多于其他科室（89%，p < 0.001）。在本可采用pRA进行的209例手术中，发现85例麻醉不充分。其中79%（67例）在急诊科进行。在45%麻醉不充分的病例中，患者接受的是局部麻醉而非合适的pRA。18%的病例疼痛控制不佳，20%的病例接受了可能不必要的全身麻醉或镇静。在17%的病例中，由于pRA不足需要额外给予氯胺酮和/或咪达唑仑。
数据表明，GRRH已经在使用pRA程序，尤其是手术室中接受高水平培训的HW。在主要由培训不足1年的医生组成的急诊科，通过将简单的神经阻滞纳入常规临床实践，有可能增加充分镇痛的实施。因此，急诊科的医生和工作人员将从基于需求的pRA培训中受益。
