Pediatric Regional Anesthesia Survey in South Africa (PRASSA): A Descriptive, Cross-Sectional Survey of Knowledge, Attitudes, and Practices Among South African Anesthetists

Authors: Kelber S et al.

Pediatric Anesthesia, First published 12 February 2026

Summary

This national cross-sectional survey examined knowledge, attitudes, and practices regarding pediatric regional anesthesia (PRA) among South African anesthetists. Despite global growth in ultrasound-guided PRA and strong international safety data, uptake in low- and middle-income countries remains inconsistent.

The online survey was distributed to members of the South African Society of Anaesthesiologists (SASA) between April–May 2024.

Key methodology details:

• 727 eligible anesthetists

• 180 initiated (24.8% response rate)

• 142 complete responses analyzed (78.9% completion rate)

• Three domains assessed: demographics/practice, attitudes (8 Likert-scale statements), and knowledge (10 true–false questions)

• Adequate knowledge defined pragmatically as ≥60% correct

Respondent profile:

• 1/3 had over 15 years of experience

• Just over 1/4 were trainees

• Practice distributed across public, private, and mixed sectors

• Formal pediatric anesthesia fellowships were uncommon

• More than half had some regional anesthesia training, but training was heterogeneous

Practice patterns:

• Fewer than 40% routinely or often performed PRA

• Continuous catheter techniques were rarely used

• Most clinicians believed they could perform PRA safely

• Common complications reported: failed/abandoned blocks and vascular puncture

• Some respondents reported altering practice after complications

Barriers and facilitators:

Primary barriers

• Lack of experience

• Insufficient training

• Time pressure

• Equipment constraints (especially pediatric-specific consumables)

• Consent concerns

Facilitators

• Surgeon support (most frequently cited)

• Mentorship

• Teamwork

Importantly, there was no significant difference in perceived equipment barriers between public and private sectors.

Attitudes:

• Overall positive toward PRA

• Strong agreement that PRA improves pediatric pain management

• Belief that PRA is beneficial in LMIC settings

However:

• Clinicians with longer duration of practice had less favorable attitudes

• All trainees expressed willingness to perform more PRA if supported with adequate training and resources

Knowledge findings:

• Fewer than 40% achieved adequate knowledge scores

• Knowledge deficits were most pronounced among trainees and non-specialists

Limitations:

• Opt-in design with modest response rate (risk of selection bias)

• Knowledge benchmark not externally validated

• Equipment variables not systematically categorized

Conclusions

PRA in South Africa remains underutilized despite generally favorable attitudes. The dominant barriers are educational and experiential rather than purely infrastructural.

The authors advocate:

• Structured, competency-based training models

• Standardized PRA curriculum development

• Short-course, high-yield “Plan A block” models (e.g., axillary brachial plexus, femoral, popliteal sciatic, rectus sheath, quadratus lumborum, caudal, dorsal penile blocks)

• Emphasis on mentorship and interdisciplinary collaboration

These findings represent the first national needs assessment of PRA in South Africa and highlight scalable strategies to improve pediatric perioperative care in resource-constrained systems.

What You Should Know

1. PRA underuse is primarily a training issue. Experience and knowledge gaps—not just equipment—limit implementation.

2. Trainees are highly receptive. There is strong willingness to expand PRA if structured support exists.

3. Surgeon buy-in is critical. Multidisciplinary engagement may be a key lever for growth.

4. Plan A block strategies may be practical in LMICs. Focused, high-yield blocks may provide the best return on training investment.

5. This mirrors broader LMIC anesthesia trends. Generalist anesthetists need scalable, competency-based models rather than subspecialty-dependent systems.

Key Points

• National survey of 142 South African anesthetists.

• PRA is infrequently performed despite positive attitudes.

• <40% met adequate knowledge threshold.

• Major barriers: training, experience, time pressure.

• Opportunities: structured training, mentorship, surgeon engagement.

Thank you to Pediatric Anesthesia for allowing us to summarize and share this important work aimed at strengthening pediatric regional anesthesia capacity in resource-limited settings.