Knowledge, attitude and practice on usage and toxicity of local anaesthetic agents (LA) amongst health care professionals in obstetrics and gynaecology

Abstract

A sound knowledge of LA and their dosage is essential for effective anaesthesia and patient safety as LA toxicity could be potentially life-threatening and clinicians undertaking LA procedures must be competent in early recognition of toxicity and instigating remedial measures timely. This is a prospective national-level survey using self-administered questionnaires among health care professionals in Obstetrics and Gynaecology primarily based in Worcestershire Acute Hospital NHS Trust and further extended to other regions of the United Kingdom. The survey was focussed on evaluating the knowledge, attitude and practice (KAP) of the common local anaesthetic agents, their dosage, early recognition and management of LA systemic toxicity(LAST). We understood that all groups of health care professionals did not demonstrate adequate knowledge of safe and effective use of LA agents. We thereby propose an accredited knowledge-based learning module, laminated safety information cards for LA use and ensuring availability of Lipid-emulsion therapy in clinical areas.

IMPACT STATEMENT

• What is already known on this subject? Health care professionals using LA should have sufficient knowledge of LA including the required and maximum dose allowance, pharmacokinetic properties, possible complications and management of systemic toxicity. The lack this can trigger potentially fatal and life-threatening complications if misused. Therefore, the key objectives of the use of LA in clinical settings are to optimise pain management while ensuring safe practice.

• What do the results of this study add? We understood that all groups of health care professionals did not demonstrate adequate knowledge of the safe and effective use of LA agents and appropriate management of its toxicity. This highlights the urgent need for extending awareness among the professionals on the safe administration of LA, early identification and prompt management of LAST. This will improve not only the safety but also the overall patient experience and quality of care.

• What are the implications of these findings for clinical practice and/or further research? We thereby propose that an accredited knowledge-based module on safe administration and safety concerns of LA must be made compulsory for all those administering LA. Laminated safety information cards on LA with explicit algorithms/guidelines should be made available in all clinical areas to avoid any delays in the management of toxicity. Moreover, all health-care institutions must ensure the availability of Lipid Emulsion Therapy.

Keywords:

• Local Anaesthetic agents (LA)
• obstetrics and gynaecology
• Local anaesthetic systemic toxicity (LAST)
• Lipid Emulsion Therapy

Third-party material

No work in this study has been reproduced or reused from any third-party materials.

Complying with ethics of experimentation

The study does not involve experiments or clinical trials on humans or animals

Informed consent

This study was a questionnaire-based study done among health care professionals clearly stating that they would be fully anonymized. All participants that took part, did it voluntarily and no personal details of the participants were noted. Hence no separate written consent was needed.

Disclosure statement

The authors- Dr Pooja Ramesh, Dr Maria Demertzi and Mr Prabath Suraweera report no conflict of interest.