An intervention trial increases the evidence-based use of bupivacaine in hand injuries.

Abstract

Published evidence indicates that bupivacaine is the superior local anaesthetic for digital nerve blocks and where long-lasting analgesia is desirable. We aimed to develop and evaluate a multifaceted education initiative designed to improve the evidence-based use of bupivacaine in hand injuries.This was a pre- and post-intervention trial undertaken in a single emergency department (ED). All physicians working in the ED were included. The intervention comprised a specifically designed "e-learning module" supplemented by in-service training, reminder techniques and improved accessibility to bupivacaine. The primary end point was the proportion of patients with hand injuries administered bupivacaine in whom bupivacaine was the most appropriate local anaesthetic. Data were collected by explicit chart review of consecutive cases.Both pre- and post-intervention periods were of 5 months' duration. The charts of 107 pre-intervention and 111 post-intervention cases were reviewed. In the post-intervention period, the appropriate use of bupivacaine increased from 14.3% to 49.4% (difference 35.2%, 95% CI 20.9 to 49.4, p<0.001); the appropriate use of lignocaine and bupivacaine increased from 38.3% to 59.5% (difference 21.1%, 95% CI 7.3 to 35.0, p = 0.003); the total number of bupivacaine ampoules issued rose by 308% (from 60 to 245); the total number of lignocaine ampoules issued decreased by 6.7% (from 2008 to 1873); and the number of files with adequate documentation increased from 56.3% to 63.4% (difference 7.1%, 95% CI -3.5 to 17.7, p = 0.20).The education initiative resulted in significant improvements in the evidence-based use of bupivacaine, and its adoption by others is recommended.