No abstract

The practice of regional anaesthesia in German speaking countries was investigated by a survey. The first part of the trilogy contains the presentation and evaluation of the data about quality assurance and training concepts. In 2002 questionnaires were mailed to 750 randomly selected departments of anaesthesia and 384 hospitals participated (51.2%). The overall proportion of regional anaesthesia was 23% and in Switzerland it was significantly higher (adults: 48%; children: 31%). Of the hospitals 19% had no person who was responsible for quality assurance. The number of puncture attempts was unlimited in 59% of the hospitals. The first training steps were observed closely (complete observation: 81%). The exact beginning (48%) and end (15%/13%) of the training were often not fixed, 80% of all anaesthesia departments requested an improvement in the training for peripheral and 53% for neuroaxial regional anaesthesia techniques. Regional anaesthesia plays a highly important role. Concepts of training and quality assurance that are backed up by evidence-based medicine should be worked out to improve the training and further education in regional anaesthesia.

The practice of regional anaesthesia in German speaking countries was investigated by a survey. The last part of the trilogy contains the presentation and evaluation of the data about the methods in obstetric anaesthesia. In 2002 questionnaires were mailed to 750 randomly selected departments of anaesthesia, 384 hospitals (51.2%) responded of which 278 had an obstetric unit. Caesarean section rate was 22.5+/-8.2% and for elective caesarean section spinal anaesthesia was mostly used. General anaesthesia was never used in 58.3% of Swiss, 10.2% of German, and 21.1% of Austrian hospitals. For non-elective caesarean section 42.1% of the hospitals often used a spinal anaesthesia, and 44.8% sometimes, in Switzerland these were 92.9% and 7.1%, respectively. Pain relief for labour was usually achieved with epidural anaesthesia or drugs. The trend from general to regional anaesthesia for caesarean section is continued, as is the trend from local infiltrative techniques to epidural anaesthesia for vaginal delivery. Switzerland was in the forefront for these developments.

The current practice of regional anaesthesia in German-speaking countries was investigated in a survey. The second part of the trilogy presents data about its use, success rates, and techniques. In 2002 questionnaires were mailed to 750 randomly selected departments of anaesthesia of which 384 hospitals participated. Peripheral regional anaesthesia is used above all in traumatology and orthopaedics, 45% of the hospitals with paediatric surgery never used neuroaxial blocks. The residents achieved mean success rates of 69.7+/-11.8% for supraclavicular plexus block to 85.5+/-9.0% for spinal anaesthesia, the specialists in anaesthesia 79.2+/-11.3% (supraclavicular plexus block) to 91.0+/-6.8% (spinal anaesthesia). Standards for basic techniques, recording of success rates, and for quality assurance of peripheral nerve blocks should be worked out to improve the application of peripheral regional anaesthesia procedures. In neuroaxial anaesthesia satisfying success rates were reached in German-speaking countries. In paediatric anaesthesia its use still has many opponents.