Background and aims Effectively analgesing an acutely injured child in ED is a challenge, even in major trauma centres (MTCs). Intranasal opioids work well but have short duration and side effects. In the current climate of an ‘opioid crisis’, analgesic alternatives are desirable, avoiding the unquantified addictive effects of opioids in children.
Paediatric regional anaesthesia (PRA) in ED is already recommended by UK professional bodies. However, PRA is usually performed under anaesthesia. Awake, injured and distressed children require a different level of preparedness and skill than simply knowing where to ‘needle’.
Methods We conducted a nationwide survey of UK MTCs to research their PRA usage. the vast majority (88%) had no structured program for ED-delivered PRA. Ad-hoc adoption of PRA yielded limited success. Therefore, despite endorsement, ED-PRA is infrequently practiced. Our audit showed that our MTC receives 250 children with limb fractures p.a., a significant analgesic task. Therefore, we designed a formal quality improvement (QI) project to introduce lower-limb PRA, in our ED. the driver diagram illustrates our key action areas.
Results ED doctors completed a course of lectures and practical stations, after required reading. Real-life block proficiency is achieved on anaesthetized, pre-operative patients. Subsequently, periodic ‘pop-up’ sessions refresh scanning and problem-solving skills. Periprocedural support and integration of ED-PRA into the multidisciplinary infrastructure was achieved by collaborative teaching for ED, nursing, physiotherapy, orthopaedic and pain colleagues. Effective governance is achieved by audit, bespoke ‘Plain English’ patient-parent information leaflets and tailored observation/troubleshooting charts.
Conclusions The project is well underway. We plan to present our QI progression at ESRA 2020.
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