Fracture local anaesthesia audit

Zero Pain Practice - Kentdale Referrals, Cumbria, UK

Authors - Katie Stott CertAVN, RVN & team

Planning the audit

Humeral Condylar Fracture Local Anaesthesia Audit

·      20 cases performed in 2025 were reviewed

·      5 Y fractures and 15 unicondylar humeral fractures

·      15 had some form of local anaesthesia (75%)

 - 3 received nerve stimulation guided brachial plexus block with bupivacaine

- 11 received blind RUMM block with bupivacaine

- 1 received intra articular injection with lidocaine

	Average intra-op rescue opioid required (methadone)	Average time to opioid top up post recovery	Post op pain scores	Ketamine CRI used intra and post op (% of cases)
No local used	0.18mg/kg	3.4 hours	0-4	80%
Intra-articular lidocaine	0.15mg/kg	1 hour	0-4	0%
Blind RUMM block with bupivacaine	0.1mg/kg	3 hours	1-7	45%
Nerve stim guided brachial plexus block with bupivacaine	0.06mg/kg	2 hours	2-5	0%

Results and discussion:

·      Local anaesthetic techniques all reduced intra-operative nociception and rescue analgesia requirements. Requirements reduced by:

- IA lidocaine: 17%

- Blind RUMM block: 44%

- Brachial plexus block: 77%

·      Average time to post recovery opioid top up was mildly decreased with local use, potentially due to intra-operative doses required in the non-local group still being in effect and the higher incidence of use of ketamine

·      Post op pain scores also slightly lower in the non-local group, again potentially due to the higher occurrence of ketamine use.

Next steps

Suggestions for future:

·      Incorporation of local anaesthetic techniques into all humeral condylar fracture analgesia plans

·      Consideration of technique; nerve locator guided brachial plexus block seems most effective with this data but only 3 cases so far using this technique so review again mid-year with more patient data

·      Regardless of the local technique used, consider ketamine CRI for post-operative period as pain scores lower with the addition of ketamine

·      Re-audit for 2026 after suggestions implemented to assess for improvement

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