Establishing a Regional Anesthesia Service in a Low-middle income country: A prospective survey of patients receiving perioperative nerve blocks at the University Teaching Hospital of Kigali (CHUK), Rwanda

Abstract

Despite the advantages of regional anesthesia as a safe, cost-effective anesthetic and analgesic technique, there is a low utilization in Low middle income countries (LMIC)[1], especially in Rwanda and in particular, at the University Teaching Hospital of Kigali (CHUK). As it is still a new service in Rwanda, ensuring efficacy and efficiency is one way to promote its use and allow its sustainability in our country especially at CHUK.

Objective We aim to quantify success of regional anesthesia practice based on data collected in patients receiving peripheral nerve blocks at CHUK, according to five parameters: 1) quantity of blocks performed, 2) block efficacy, 3) block safety, 4) block efficiency and 5) perioperative team member satisfaction

Method This is a prospective clinical survey of all patient receiving peripheral nerve blocks anesthesia at CHUK, from April until September 2016 (6 months)

Results Of 60 patients, 40 were male and 20 female, sex ratio (male: female) was 1:2. The ages ranged from 13 years to 85 years. The majority of peripheral nerve blocks were done by residents, 34 cases (56,7%), consultants 21 cases (35%), and non-physician anesthetists 5 cases (8,3%) The majority of blocks were upper extremity nerve blocks with supraclavicular nerve blocks in 41 cases (68,3%), intercostobrachial in 16 cases (26,7%), interscalene blocks in 8 cases (13,3%), axillary in 5 cases (8,3%). Lower extremity blocks included one popliteal block (1,7%), one femoral nerve block (1,7%) and one ankle block (1,7%). The success rate was at 95%, 2 blocks (3%) required supplementation or top-up to complete the peripheral nerve blocks and one peripheral nerve block required a deep sedation (1,7%) using propofol with midazolam. The use of monitoring was 100% for the use of pulse oximetry, 86,7% for the use of non-invasive blood pressure. Sterility measures included 100% use of sterile gloves, 100% use of skin cleaning solution and 92% use of probe covers ( also known as condoms). Team satisfaction

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was high, with a 94,04% satisfaction rate among surgery team, and 94% satisfaction rate from patients.

Conclusion A local regional anesthesia service established in a resource-limited academic teaching hospital delivered a reasonable quantity of peripheral nerve blocks with demonstrated efficacy, safety, minimal complications and excellent satisfaction amongst staff and patients.