To become competent in all generic aspects of block performance
Able to obtain consent for regional anaesthesia from patients
Create a safe and supportive environment in theatre for awake and sedated patients
Demonstrate knowledge of the principles of how to perform a number of regional and local anaesthetic procedures
Be able specifically to perform spinal and lumbar epidural blockade
Be able to perform some simple upper and lower limb peripheral nerve blocks under direct supervision
Be able to use a peripheral nerve stimulator or ultrasound to identify peripheral nerves
Demonstrate clear understanding of the criteria for safe discharge of patients from recovery following surgery under regional blockade
Recognise that they should not attempt blocks until they have received supervised training, and passed the relevant assessments
Accepts the right of patients to decline regional anaesthesia, even when there are clinical advantages Core clinical learning outcomes:
Demonstrates safely at all times during performance of blocks including: marking side of surgery and site of regional technique; meticulous attention to sterility; selecting, checking, drawing up, diluting, and the adding of adjuvants, labelling and administration of local anaesthetic agents
Establish safe and effective spinal and lumbar epidural blockade and manage immediate complications in ASA 1-2 patients under distant supervision
Ability to establish a simple nerve block safely and effectively
Knowledge
RA_BK_01 Recalls/describes the anatomy relevant to regional and peripheral blocks identified
RA_BK_02 Recalls the relevant physiology and pharmacology [including toxicity of local anaesthetic agents, its symptoms, signs and management, including the use of lipid rescue]
RA_BK_03 Recalls the relevant physics and clinical measurement related to the use of nerve stimulators in regional anaesthesia
RA_BK_03A Recalls the relevant basic physics and clinical application of ultrasound to regional anaesthesia in respect of:
The components of an ultrasound machine
The interaction of ultrasound with tissues
Picture optimisation using hand movements, adjustment of depth, gain and focus
RA_BK_04 Discusses the advantages/disadvantages, risks/benefits and indications/contra-indications of regional blockade RA_BK_05 Describes how to obtain consent from patients undergoing regional blockade RA_BK_06 Outlines the basic functions of an ultrasound machine [including physics [ref Basic Sciences], picture optimisation and probe selection] and how nerves to and in the upper limb can be identified using ultrasound RA_BK_07 Describes the principles of performing the following regional and local anaesthetic procedures:
Subarachnoid and Lumbar/caudal epidural blockade
Brachial plexus blocks: axillary, interscalene and supraclavicular
Other more distal upper limb blocks [elbow and wrist]
Lower limb blocks [femoral, sciatic and ankle]
Ilio-inguinal nerve blocks/penile blocks
Ophthalmic blocks [Cross reference to ophthalmic anaesthesia]
Intravenous Regional Anaesthesia [IVRA]
RA_BK_08 Demonstrates understanding of the use of continuous epidural infusions and the need to prescribe correctly RA_BK_09 Recalls/discusses the complications of spinal and epidural analgesia and their management including, but not exclusively, accidental total spinal blockade and accidental dural tap and post-dural puncture headache RA_BK_10 Describes techniques and complications of other blocks listed in RA_BK_07 RA_BK_11 Shows understanding of the principles of identification of correct anatomy including the use of nerve stimulators and ultrasound [Cross reference Ultrasound] RA_BK_12 Outlines the dangers of accidental intravenous administration of local anaesthetic drugs, signs, symptoms and management, including the role of lipid emulsion RA_BK_13 Outlines the management of incomplete or failed regional blockade including, where appropriate, the use of rescue blocks RA_BK_14 Demonstrates understanding of the methods of sedation used in conjunction with regional anaesthesia RA_BK_15 Recalls/describes absolute and relative contraindications to regional blockade RA_BK_16 Outlines the possible effects regional blockade will have on the patient, list and the theatre staff and how these may be managed RA_BK_17 Lists the advantages and disadvantages of regional anaesthetic techniques for post-operative analgesia RA_BK_18 Describes the problems and solutions to obtaining adequate post-operative analgesia in the ward or home [if discharged] setting when the regional anaesthetic wears off RA_BK_19 Understands the need to review patients or contact patient following regional anaesthetic techniques to ensure block has worn off and there are no residual complications RA_BK_20 Understand the necessity to document the procedure and any complications e.g. paraesthesia, vascular puncture, pneumothorax and record images / video clip if using ultrasound where appropriate or indicated RA_BK_21 Be aware of the use of information leaflets in the decision making process and in the reporting of problems or complications following discharge RA_BK_22 Recalls the relevant basic physics and clinical application of ultrasound to regional anaesthesia [Cross ref basic sciences;physics and clinical measurement] in respect of:
The components of an ultrasound machine
The interaction of ultrasound with tissues
Picture optimisation using hand movements, adjustment of depth, gain and focus
RA_BS_01 Obtains valid consent for regional blockade, including confirmation and marking of side of operation and site or regional technique where indicated RA_BS_02 Demonstrates safe and correct checking of the contents of epidural / spinal packs RA_BS_03 Practices safely including: meticulous attention to sterility during performance of blockade; selecting, checking, drawing up, diluting, adding adjuvants, labelling and administration of local anaesthetic agents RA_BS_04 Demonstrates how to undertake a comprehensive and structured pre-operative assessment of patients requiring a subarachnoid blockade, perform the block and manage side effects/complications correctly RA_BS_05 Demonstrates how to undertake a comprehensive and structured pre-operative assessment of patients requiring a lumbar epidural blockade, perform the block and manage side effects/complications correctly RA_BS_06 Recognises which patients are unsuitable for regional blockade RA_BS_07 Recognises patients in whom a block would be difficult to perform RA_BS_08 Demonstrates the management of hypotension, nausea, anxiety and shivering induced by spinal or epidural blockade RA_BS_09 Demonstrates correct post-operative care following spinal or epidural block RA_BS_10 Demonstrates how to use epidural techniques for post-operative pain management RA_BS_11 Demonstrates how to perform some simple nerve blocks from amongst the following:
Femoral
Ankle
Elbow, wrist and or digital
Rectus sheath
Inguinal
Intercostal
Infiltration techniques
RA_BS_12 Shows how to use sedation correctly during surgery under regional blockade RA_BS_13 Manages patients with combined general and regional anaesthesia RA_BS_14 Shows consideration for the views of patients, surgeons and theatre team with regard to surgery under regional blockade RA_BS_15 Shows the ability to correctly manage the theatre environment with an awake or sedated patient RA_BS_16 Demonstrates list planning to allow time for the conduct of a block and for it to take effect RA_BS_17 Shows good communication skills towards the patients and staff during the use of regional blockade RA_BS_18 Shows due care and sensitivity to the patient’s needs during performance of regional block RA_BS_19 Demonstrates how to identify peripheral nerves using basic ultrasound technology [e.g. the median, radial and ulnar in the arm]
