Regional anaesthesia in the emergency centre: Knowledge, attitudes and practices of doctors in the Western Cape, South Africa

Abstract

Background: Regional anaesthesia in emergency centres (ECs) offers clear benefits for patient care and system efficiency. However, its use in South African ECs remains inconsistent, and the knowledge, attitudes and practices of emergency doctors are not well understood. A notable gap exists in formal training.
Methods: A cross-sectional survey was conducted among EC doctors at four district hospitals in the Metro-East health district of the Western Cape, South Africa. Data were collected via an electronic questionnaire exploring knowledge, attitudes and practices related to regional anaesthesia.
Results: Eighty-five doctors participated (58% response rate). Among them, 67.1% had prior training in peripheral nerve blocks, predominantly informal and peer-based (98.2%), with only 8.8% receiving formal training. Most (96.5%) expressed interest in further training. Regional anaesthesia was underused: 36.5% used it less than monthly, 23.5% weekly and only 2.4% daily. Despite this, 77.6% rated it as important or very important, and 75.3% scored its usefulness ≥ 7/10. Barriers included limited confidence in managing local anaesthetic toxicity and inconsistent monitoring: 39.1% never monitored, while only 25% did so consistently. The most cited barrier (92.9%) was a lack of knowledge.
Conclusion: Despite strong interest and favourable attitudes, regional anaesthesia remains underutilised because of limited knowledge, informal training and concerns about safety and monitoring.
Contribution: This study reveals a disconnect between positive clinician attitudes and limited practical competence. It underscores the need for structured, formal educational initiatives to support safe and effective regional anaesthesia use in district ECs.