Goals and Objectives for the Regional Anesthesia Rotation
Goal
Regional anesthesia is a rotation one month for CA2 and/or CA3 anesthesiology residents. This rotation is designed to gain consultant attributes as well as learn peripheral nerve blocks and management of post anesthesia pain. The purpose of this rotation is to gain knowledge and expertise in the art and science of variety of regional anesthesia techniques both for surgical anesthesia and analgesia. The regional anesthesia techniques we will focus on during this rotation will be for upper and lower extremity blocks and some blocks for the thoraco-abdominal trunk. They will also learn about the complications associated with regional anesthesia and their management. The patients with indwelling perineural catheters for postoperative pain control will be followed by the residents who are assigned to the regional anesthesia rotation so they can gain expertise in management of postoperative pain.
Objectives
During this rotation instruction will be limited to performing blocks for the extremities and the trunk. They will not be expected to learn about spinal, epidural or intravenous regional anesthesia. Learning objectives are designed based on the seven attributes. They will learn to perform the blocks using different techniques including the use of ultrasound. They will learn to do single shot blocks as well as placement of peineural catheters. At the end of the rotation each resident will be evaluated using the same seven attributes.
Patient Care
Residents are expected to
- Review the surgical schedule on the previous day to determine which cases are suitable for blocks
- Consult with the Block Faculty about those cases.
- Conduct a thorough preoperative evaluation including pertinent laboratory values for each patient. This should also include the purpose and the procedure for the block.
- Provide adequate information about the risks and benefits of various peripheral nerve blocks to all patients prior to performing the block and document that on the form
- Make sure there are no contraindications for the block
- Determine appropriate sedation for patients receiving the block
- Determine the appropriate block for the surgical procedure
- Assure patient safety, including time out, site and side verification and appropriately filled out and signed consent form for the surgical procedure.
- Be prepared with appropriate monitoring, and availability of resuscitative equipment and medications
- Be familiar with various gauges, lengths and echogenicity of the block needles available
- Be familiar with the stimulator use for the nerve stimulation techniques
- Be respectful and attentive to patient needs. Answer questions. Develop bedside manners that can improve patient confidence and reduce anxiety prior to performing a block
- Perform various peripheral nerve blocks document the details of the block on the BLOCK FORM and record the vital signs on the anesthetic record
- Learn to supplement and deal with inadequate anesthesia or analgesia
- Assure safe transfer of care to the primary anesthesia team
- Gain knowledge about the Ultrasound and it application to regional anesthesia
- Be familiar with sonoanatomy
- Perform peripheral nerve blocks using ultrasound guidance
- Print and ultrasound picture of the block performed and place in the patient's record
- Learn to place perineural catheters for postoperative pain control
- Mange the perinerual catheters and place appropriate orders for their management on the ward
Knowledge
Residents are expected to
- Understand the anatomy of brachial plexus and innervations of the upper extremity
- Understand the anatomy of lumbo-sacral plexus and innervations of the lower extremity
- Understand than anatomy of the paravertebral space
- Learn about indications, contraindications, various approaches and complications associated with peripheral nerve blocks
- Know the pharmacology of local anesthetic agents and additives used for the block
- Know the onset, and duration of the local anesthetic agents
- Prevent, recognize and treat local anesthetic toxicity
- Understand various peripheral nerve stimulators and their uses
- Learn about he various insulated needles for the block and stimulating catheters
- Learn about the principles of ultrasound and their applications
- Learn about billing codes and their importance
Practice -Based Learning
Residents at this level of training should have acquired critical thinking skills. They must be able to learn from experiences. They must know how to look for the information and hoe to assimilate it. They also should be able to further their education and improve the patient care by applying the knowledge. The knowledge and experience in regional anesthesia should make them competent to offer alternative anesthetic and analgesic techniques for the critically ill patients.
Residency training is an apprenticeship and practice of medicine should be a continuous learning exercise.
To enhance learning, residents are expected to
- Critically evaluate his/her performance in an objective fashion
- Use clinical experience to identify practice features that could be improved
- Modify practice based on experience
- Justify clinical choices using scientific knowledge
- Study regularly and assimilate new knowledge into patient care
- Locate and appraise scientific studies to guide patient care
- Facilitate learning of medical students, junior residents and off-service residents
Interpersonal and Communication Skills
Patient care requires effective communication skills.
Residents are expected to
- Communicate with the peri-operative care team including the holding area nurses, anesthesia care team, and the surgical team to assure patient safety.
- Discuss about the potential for performing blocks for patients assigned to their rooms
- Send for these patients in a timely fashion to avoid delays for the operating suite
- Be respectful and establish a sound rapport with the patient and the family
- Reduce patient anxiety
- Explain the benefits, risks and the choice of the particular block in a language that the patient can understand.
- Answer all questions truthfully
- Communicate effectively with the peri-operative team
- Provide clear, concise and legible record of the block done and in untoward events if any
- Keep the team informed about the changes in the patient's status if any
Professionalism
Patient care is effectively practiced in a professional atmosphere. Anesthesiology residents can help maintain an atmosphere of professionalism if he/she
- Consistently demonstrates compassion for patients and patient's family
- Places patient's interest above one' own
- Consistently demonstrates respect for the medical profession through his or her behavior that is characterized by dependability, respect for colleagues, dignity
- Attends promptly to any identified problems
- Is accessible, available and truthful
- Is willing to acknowledge and learn form one's errors
- Accepts criticisms in a constructive manner
- Is punctual and prepared
- Demonstrates accountability for their actions to the patient, profession and society
- Demonstrates commitment to ethical principles and patient confidentiality
System-Based Practice
Residents are expected to
- Demonstrate knowledge of how their actions impact future care to a given patient
- Demonstrate knowledge and concern for cost-effective care
- Demonstrate awareness and responsiveness to the larger context of health care
- Extensively use systemic approach to reduce errors
- Consult the faculty or other services when the need arises
