Regional anaesthesia

Regional anaesthesia – Core Learning Outcomes

  • 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]