Regional analgesia in Italy: a survey of current practice

Two decades of attention have focused on regional anesthesia, both central neuraxial blockades as well as peripheral blocks. Though there are a considerable number of recent publications on the topic, the complex issues around the effect of regional anesthesia on outcome have not been completely resolved, possibly because the data are often not procedure-specific. In this survey, we tried to focus on current Italian practice and therapeutical criteria in the management of postoperative pain. We also evaluated how the clinical practice of the respondents follows the international and national guidelines for postoperative pain. A questionnaire was mailed to 64 anesthesiologists who had been identified from a database kept by the RICALOR Group (Registro Italiano Complicanze Anestesia LOcoRegionale – Italian Registry of Complications during Locoregional Anesthesia). The survey requested information regarding demographic data and general management, postoperative pain management and guidelines, and specific questions on epidural analgesia and on peripheral blocks. Only 35 of the 64 anesthesiologists answered the questionnaire and sended it back for analysis. Basing on these 35 returns, data from 51 surgical units (some respondent referred data of more surgical units) leading to 135 departments (surgical units may be constituted by more departments) were analyzed. A total of 245,382 surgical procedures were analyzed. Regional analgesia was used in 46.71% of the procedures. In university and teaching-hospitals, protocols concerning regional anesthesia were attended and shared with the whole staff more often than in non-teaching hospitals (P = 0.0001). For postoperative pain management 31.48% of responders used <10% of regional analgesia, 20.37% used 10–30%, 25.93% used 30–50%, 14.81% used 50–75% and 7.41% used >75% of regional analgesia. We identified a huge variety of responses regarding therapeutical protocols but the majority of responders used the drugs with the best safety/efficacy profile. In conclusion, we demonstrated an improvement in the management of postoperative pain compared to previous studies, but still efforts should be made to standardize daily practice in order to avoid complications and improve safety.