Paediatric regional anaesthesia,a survey of practice in the United Kingdom

Background. A variety of techniques and drugs, many unlicensed,is used in paediatric regional anaesthesia. This study is thefirst to survey paediatric anaesthetists about the techniquesand drugs used in paediatric regional anaesthesia. The aim isto provide a record and benchmark of UK practice. Methods. A postal questionnaire was sent to all members of theAssociation of Paediatric Anaesthetists residing in the UK.Information was requested on the type of hospital worked in,years of practice, paediatric anaesthesia workload, regionalanaesthesia techniques used, and drugs used in regional anaesthesia. Results. A total of 220 responses from 264 questionnaires (83.3%)were received. Of these respondents, 155 (70%) practised paediatricanaesthesia as more than 50% of their workload, and 10 had retiredor returned blank forms. Two hundred and two of 210 (96%) usecaudal anaesthesia and 151 (72%) use caudal, epidural and peripheralblock. One hundred and ninety-two of 210 (91%) have no lowerage limit for using caudal anaesthesia. One hundred and twenty-threeof 210 anaesthetists (58%) used adjuvants with local anaestheticsin caudal block, the most common being fentanyl [44/210 (21%)],clonidine [55/210 (26%)], diamorphine [27/210 (13%)] and ketamine[67/210 (32%)]. Those working in specialist centres or teachinghospitals or who had a greater paediatric anaesthesia workloadwere more likely to use a greater variety of regional anaesthesiatechniques. Conclusions. Caudal anaesthesia is widely used for patientsof all ages by almost all practitioners. Most anaesthetistsat all hospital types and experience levels use adjuvants withlocal anaesthetics when performing caudal anaesthesia. Thosewith more experience in paediatric anaesthesia and those inspecialist centres commonly use other neuraxial and peripheralblock techniques. Br J Anaesth 2002; 89: 707–10