ArticleBMC anesthesiology2026
Expert perspectives on the requirements for implementing prehospital peripheral nerve blocks: a survey among members of the European Society of Regional Anaesthesia (ESRA).
Article in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
backgroundEvidence on prehospital regional anesthesia (RA) is limited, with only a few trials comparing peripheral nerve blocks (PNBs) to standard opioid analgesia. Although well established in hospitals, their use in prehospital care remains rare. This survey aimed to capture expert perspectives on prerequisites, barriers, and preferred block techniques for broader implementation of prehospital PNBs.
methodsMembers of the European Society of Regional Anaesthesia (ESRA) were invited to participate in an anonymous online survey. The 30-item questionnaire collected demographic data, professional background, information on the organization of emergency medical services (EMS), and ultrasound availability. Participants were also asked about their experience with in-hospital and prehospital RA, perceived training requirements, and necessary equipment. Finally, respondents assessed the advantages, disadvantages, and suitability of specific RA techniques for prehospital scenarios. Data were analyzed descriptively and are presented as absolute numbers and percentages.
resultsA total of 415 fully completed questionnaires were included in the analysis. 82% (342/415) of respondents supported prehospital RA, but only 20% (73/415) reported its current use in their EMS area. Onethird of this group had personally performed RA procedures, with fascia iliaca compartment blocks (FICB) and femoral nerve blocks (FNB) being the most frequently used techniques. The most commonly cited key requirements for performing prehospital RA included ultrasound devices (87%; 359/415) and lipid solution (68%; 282/415). 58% (240/415) of respondents reported ultrasound availability in prehospital care. 63% (262/415) believed only specialists or residents with additional training should perform PNBs.
conclusionWhile most respondents supported the concept of prehospital RA, only few indicated that such approaches are currently implemented in their local EMS systems. FICB and FNB were identified as the preferred options for managing proximal femur fractures. Key concerns regarding implementation included limited team experience, time constraints, and procedural complications such as local anesthetic systemic toxicity (LAST), emphasizing the need for structured training, clear protocols, and expert guidance to ensure safe implementation.
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