A survey of anaesthetic management of regional anaesthesia for patients undergoing arthroscopic shoulder surgery in Australia

Background The Australian and New Zealand College of Anaesthetists recommends standards of monitoring and conduct for regional anaesthesia but does not endorse specific regional techniques. While the interscalene block is the de-facto standard technique, there are numerous established and novel alternatives. Regional block choice and block-related variables (local anaesthetic type, dose, volume, adjuncts) are subject to individual and institutional practices. Methods Using a 30-question survey, we aimed to create a snapshot of current regional anaesthesia practice for patients undergoing arthroscopic shoulder surgery across Australia and New Zealand. Results Among 134 anaesthetist respondents, 85.1% routinely placed a regional block for arthroscopic shoulder surgery. 91.2% performed interscalene blocks. Ropivacaine 0.375% and 0.75% were the most common concentrations and type. Regional anaesthesia under light sedation and general anaesthesia were performed by 47.4% and 30.7% block-respondents respectively. 96.5% of block-respondents used ultrasonography. 49.1% of block-respondents recorded written consent. 86.0% always performed a consent/site/side check. Standard monitoring was variably applied for blood pressure, electrocardiography and end-tidal carbon dioxide monitoring. Postoperatively, patient-controlled analgesia was not routinely prescribed. Conclusion Variation exists for regional anaesthesia techniques for arthroscopic shoulder surgery with most performing interscalene blocks with ultrasonography. This study highlights topics of debate including level of consciousness during block performance and questions around monitoring and consent to help inform future guidelines.