How UK obstetric anaesthetists assess neuraxial anaesthesia for caesarean delivery: National surveys of practice conducted in 2004 and 2010

Husain, Tauqeer; Liu, Y.M.; Fernando, Roshan; Nagaratnam, V.; Sodhi, Mohit; Venkatesh, S; England, A. J.; Columb, Malachy O.

doi:10.1016/j.ijoa.2013.07.002

Cited by 22 publications

(23 citation statements)

References 15 publications

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“…It also means that if a patient feels pain during caesarean section, it is challenging to ascertain whether they have been treated according to standard practice, as this varies widely between not only practitioners [2][3][4], but also those doing research in the field.…”

Section: Discussionmentioning

confidence: 99%

“…It also only relates to assessment of pinprick sensation, so would be unlikely to be used by the majority of UK anaesthetists, who still use an assessment of cold [4]. Furthermore, given the varied and inconsistent use of the 'Bromage' scale for motor block, it could be argued that the confusion surrounding sensory assessment would not be solved by the development of a scoring system that was similarly open to multiple interpretations.…”

Section: Discussionmentioning

confidence: 99%

“…There are multiple different methods of assessing the block, and surveys have consistently demonstrated a marked variation in techniques among anaesthetists [2][3][4]. There is also no standard of documentation, and even comparatively fixed points, such as the dermatome being assessed, have been shown to be recorded differently by different operators [5,6].…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, a block to touch at T5 is often quoted as a medicolegal standard [8]. However, surveys of practice have consistently demonstrated that assessment of cold is most frequently performed before caesarean section [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, response rates of 70% and above have been suggested as being necessary to provide meaningful estimates [9]. The three surveys referred to above have reported response rates of 71% in 1996 [2], 72% in 2004 [3], but only 45% in 2010 [4].…”

Section: Introductionmentioning

confidence: 99%

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Assessing the height of block for caesarean section over the past three decades: trends from the literature

Hoyle

Yentis

2014

Anaesthesia

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SummaryThere are multiple methods of assessing the height of block before caesarean section under regional anaesthesia, and surveys of practice suggest considerable variation in practice. So far, little emphasis has been placed on the guidance to be gained from published research literature or textbooks. We therefore set out to investigate the methods of block assessment documented in published articles and textbooks over the past 30 years. We performed two searches of PubMed for randomised clinical trials with caesarean section and either spinal anaesthesia or epidural anaesthesia as major Medical Subject Headings. A total of 284 papers, from 1984 to 2013, were analysed for methods of assessment of sensory and motor block, and the height of block deemed adequate for surgery. We also examined 45 editions of seven anaesthetic textbooks spanning 1950-2014 for recommended methods of assessment and height of block required for caesarean section. Analysis of published papers demonstrated a wide variation in techniques, though there has been a trend towards the increased use of touch, and an increased use of a block height of T5 over the study period. Only 115/284 (40.5%) papers described the method of assessing motor block, with most of those that did (102/115; 88.7%) describing it as the 'Bromage scale', although only five of these (4.9%) matched the original description by Bromage. The required height of block recommended by textbooks has risen over the last 30 years to T4, although only four textbooks made any recommendation about the preferred sensory modality. The variation in methods suggested by surveys of practice is reflected in variation in published trials, and there is little consensus or guidance in anaesthetic textbooks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%