Regional anaesthesia






“Regional techniques are integral components of anaesthesia in the UK now, but the College recognises that it is inappropriate to expect that every trainee will become competent in every possible block technique, although they must be competent in all the generic aspects of block performance. Schools of Anaesthesia will vary in the range of blocks to which trainees can be exposed, but the SHO curriculum has indicated that all trainees should become competent in spinal and epidural block, with training in certain other blocks being appropriate at that stage if possible. In SpR years 1-2 trainees should increase their experience of regional techniques and, where opportunities allow, should increase the range of block techniques in which they become competent. The skills section below indicates the techniques which are considered most appropriate for this stage of training, experience of the various techniques normally being gained during relevant sub-specialty attachments. If training in these blocks is not available it should be deferred to Years 3 / 4 / 5, or even until after achievement of CCT if an individual subsequently wishes to practice them”.

General aspects

  1. Principles of Regional Anaesthesia
    1. Advantages/disadvantages, risks/benefits and the absolute and relative indications/contra-indications
    2. Assessment, preparation and management of the patient for regional anaesthesia, including a discussion of anaesthetic options
    3. The principles of performing minor and major peripheral nerve blocks (including cranial nerve blocks) and central neural blocks
    4. Desirable effects, possible side effects and complications of regional anaesthesia
    5. Management of effects and complications
  2. Management of the complications of spinal and epidural (including caudal) analgesia (associated hypotension, shivering, nausea & anxiety, retention)
  3. Post-operative care following spinal or epidural block (including urinary retention)
  4. Management of the patient receiving regional techniques in the postoperative period, including liaison with surgeons, acute pain teams, and ward staff
  5. Techniques and complications of intravenous regional anaesthesia (IVRA),
  6. Management of failed/ deteriorating regional block
  7. Performance of some simple peripheral nerve blocks
  8. Combined general and regional anaesthesia
  9. Techniques for continuous local anaesthesia

Neuraxial blockade

  1. Single shot and catheter techniquesfor:
    1. Spinal anaesthesia
    2. Epidural block (Lumbar, Sacral and Caudal)
    3. Combined spinal /epidural

Plexus blocks – see also Chronic Pain

  1. Brachial plexus – one technique at least

Limb blocks

  1. Major nerve block – able to perform at least one method for upper and lower limb surgery respectively:
  2. Upper limb (elbow and distal)
  3. Sciatic
  4. Femoral
  5. Lower limb (ankle & distal)

Other

  1. Trunk
  2. Penile
  3. Intercostal
  4. Inguinal blocks
  5. Miscellaneous: Superficial cervical plexus block, Ophthalmic blocks, topical, IVRA, infiltration & intra-articular

 

“[Note: Thoracic epidural and deep cervical plexus blocks are SpR 3/4/5 competencies. A fuller range of ‘major’ nerve block techniques would be appropriate at SpR 3/4/5 level also if the relevant training and experience are available. Cranial nerve, cervical epidural, paravertebral, lumbo-sacral and autonomic block competencies are appropriate only to senior trainees working towards competency in pain and other relevant sub-specialties”.

 

CEACCP 2004: APRIL
MR Checketts and JAW Wildsmith
Regional block and DVT prophylaxis

CEACCP 2006: APRIL
Stephen Ridgway and Martin Herrick
Perioperative nerve dysfunction and peripheral nerve blockade

CEACCP 2001: OCTOBER
S Burnell and AJ Byrne
Continuous spinal anaesthesia

CEACCP 2005: APRIL
JB Whiteside and JAW Wildsmith
Spinal anaesthesia: an update

CEACCP 2002: APRIL
MF Al-Haddad and DM Coventry
Brachial plexus blockade

CEACCP 2005: FEBRUARY
Stuart A Grant and Dara S Breslin
Continuous peripheral nerve blockade

CEACCP 2003: AUGUST
MF Al-Haddad and DM Coventry
Major nerve blocks of the lower limb

CEACCP 2005: OCTOBER
A Kopka and MG Serpell
Distal nerve blocks of the lower limb

CEACCP 2004: FEBRUARY
GA McLeod and C Cumming
Thoracic epidural anaesthesia and analgesia