W. Rook, A. Moriarty

Birmingham Women's and Children's NHS Foundation Trust, UK

Introduction & Aims

We present data on the changes in anaesthetic approach to common surgical procedures in a large tertiary paediatric hospital over 15 years.


Consultant anaesthetists at Birmingham Children’s Hospital were anonymously surveyed in 2008, and in 2023. They were asked what their ‘Plan A’ approach to the perioperative anaesthesia and analgesia for each procedure would be, in the absence of specific circumstances strongly favouring or contraindicating a particular approach. 2023 responses were collected via google forms, and compared with previously collected data.

19 consultant anaesthetists responded for all procedures in 2008, while 18-20 consultant anaesthetists replied for each procedure in 2023.


For laparoscopic nephrectomy, there was a shift from 100% volatile to 28% TIVA, while epidural use declined from 35% to 5%. Paravertebral blocks were not used at all in 2008, but were used in 77% of cases in 2023.

For hypospadias repair in a 4yr old, there was a move from 100% volatile to 38% TIVA, while the use of caudal analgesia remained the primary plan in 94% of cases, unchanged between 2008-2023. In a similar vein, in the 6 month old for hypospadias repair, there was a smaller move from 100% volatile to 16% TIVA, while 100% of respondents use a caudal block as their primary analgesia across both iterations of the survey.

For repair of trachea-oesophageal fistula, all respondents use volatile as their primary anaesthetic technique. However, there was a move from 100% offering an epidural in 2008, to only 5% in 2023, preferring to use a paravertebral block (38%) or wound infusion catheters (11%).

Respondents plans for Inguinal hernia repair in the term neonate, and the premature neonate remained 100% volatile-based. Similarly in the term neonate 100% of respondents offered a caudal, with a small move away from using a caudal in premature neonates (72% - 63%), with more offering simply infiltration with local anaesthetic (38% in 2023).

Approaches to neonatal laparotomy followed a similar pattern, remaining 100% volatile based, but with a move away from epidural/caudal catheters (100% - 10%), favouring use of TAP blocks (31%) and wound catheters (51%) in 2023.

Respondents approach to Repair of Talipes also moved away from central neuraxial approaches. Caudal use reduced from 84% to 21%, with clinicians favouring peripheral nerve blockade (74%), and ‘NCA’ (nurse controlled analgesia, 21%) .


Overall, we have found a move from volatile to TIVA based anaesthesia in older children, while volatile remains the primary anaesthetic technique for neonates. We have also found a marked move away from neuraxial blockade as the primary analgesia, favouring more peripheral regional anaesthetic techniques. It would be interesting for other departments to perform similar work to compare.

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