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Background and Aims Triple monitoring (TM) involves the use of a nerve stimulator, ultrasound imaging and a pressure limiting device (PLD), particularly when performing plexus blocks and peripheral nerve blocks (PNB). Alongside performing regional anaesthesia (RA) in awake patients, TM is seen as the gold standard in monitoring. The aim of this study was to determine how anaesthetists monitor their administration of RA.
Methods Fifty peripheral nerve blocks were audited for monitoring standards. Documentation for each block was retrospectively analysed. In addition, a survey was sent to all anaesthetists to gather current monitoring standards used in regional anaesthesia, and knowledge regarding how to use pressure limiting devices and nerve stimulators.
Results One peripheral nerve block (2%) was performed using a PLD. In 22% of cases a nerve stimulator was used in addition to ultrasound imaging. Ultrasound imaging was used in all cases. The survey had 29 respondents. Twelve percent claimed to use TM whenever performing a PNB. One third of respondents admitted to never using a nerve stimulator when performing regional anaesthesia. Only 32% of respondents were aware that a response to stimulation seen at 0.4mA should raise concerns regarding the possibility of intraneural injection.
Conclusions Routine follow up after RA is not seen in most anaesthetic departments. The presence of nerve injury as a result of RA may also be over-reported, since the incidence may be confounded by a injury caused surgically. In the absence of a formalised follow up pathway, we should be aiming to follow best practice and use TM when performing PNBs.
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