ANAESTHES IA
Improving safety in regional anaesthesia
A new NHS invention is giving anaesthetists greater control and reduces the risk of nerve damage, when performing regional anaesthesia.
Over 20 million regional anaesthetic nerve blocks are performed each year throughout the EU and US.1
Current procedures require
two operators, an anaesthetist to position the needle using an ultrasound probe for guidance and an assistant to operate the syringe to inject the anaesthetic solution. The current process relies heavily on the assistant’s interpretation of the pressure prior to injection.
This is highly subjective and ‘syringe feel’ varies between individuals, thus creating the risk for anaesthetic solutions to be injected at high pressure. Safira (SAFer Injection for Regional Anaesthesia), initially devised by a group of clinicians from the NHS, addresses this problem. It brings a new technology to regional anaesthesia and is the first device to both turn the regional block process into a one-person procedure and introduce a built-in safety element to help prevent injection at high pressures.
The challenges of current regional anaesthesia practice
A regional block procedure involves using injections of local anaesthetic to anaesthetise a specific area of the body (such as the leg
or arm) by blocking the nerve to provide pain relief during surgery. It means patients can stay awake but remain pain-free during invasive surgery without requiring a general anaesthetic. Peripheral nerve blocks are one of the most common types of regional anaesthesia (RA).
During this procedure, the anaesthetic is injected near a specific nerve or bundle of nerves to block sensations of pain from a specific area of the body, more commonly for surgery on the arms and hands, the legs and feet, or the face. For patients, regional anaesthesia offers a number of advantages over general anaesthesia, including faster recovery time and fewer side effects, and eliminates the need for an airway device during surgery.
Current regional anaesthesia practice requires two operators: an anaesthetist who holds an ultrasound probe in one hand and uses this to guide the needle tip placement
The assistant can find it difficult to judge the pressure correctly and less than 4% of anaesthetists are confident their assistants are applying the correct pressure. High pressures have been shown to damage the nerve fascicles and can cause serious nerve damage
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with the other hand. The assistant is then required to inject the anaesthetic solution, applying their judgement to decide if the pressure in the syringe is at a safe level before the injection is made. Studies have shown, however, that the assistant can find it difficult to judge the pressure correctly and less than 4% of anaesthetists are confident their assistants are applying the correct pressure.2
High
pressures have been shown to damage the nerve fascicles and can cause serious nerve damage.3 Dr. John Gibson, one of the pioneers behind Safira, explains: “Ultrasound guided regional anaesthesia is a three-handed technique. The first hand is used to hold the ultrasound probe. “The second hand, usually the dominant hand, is used to guide the block needle. A third hand is required to inject the local anaesthetic, hence a second person – an assistant – is needed to give the injection. “However, a potential complication of regional anaesthesia is nerve injury, which can be potentially life changing. One way that the risks of this can be significantly reduced is if the injection is only given when the pressure required to inject is below a certain level, or the force on the syringe plunger required to inject is small.” So, how can an NHS inspired technology change working practices and help reduce the risks of nerve injury in patients?
MARCH 2021
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