Regional Anesthesia Rotation.

Table of Contents

1. Goals and Objectives for the Regional Anesthesia Rotation
2. Daily Routine
3. Equipment for Blocks
4. Ultrasound
5. Ultrasound Equipment
6. Suggested Reading

Daily Routine

Resident/residents assigned to the block rotation are responsible for the following

1. Please review the surgery schedule the day before and identify the potential cases for the peripheral nerve blocks. Discuss their management with the faculty assigned to do the blocks.
2. On the morning of surgery communicate with the anesthesia team assigned to the patient.
3. Please communicate with the circulating nurse in the room and the nurse in the holding area so they can send for the patient 30-45 minutes ahead of time. This can prevent the delay in the operating rooms
4. Please make sure that the equipment needed to perform the block is available and

In working order

5. Please test and make sure that resuscitation equipment is ready.
6. Please be familiar with local anesthetic toxicity and its treatment including the lipid emulsion infusion for bupivacaine toxicity
7. Please explain to the patient the purpose of the block, technique and potential risks in a language the patient can understand.
8. Please make sue the patient is checked in before you transfer the patient to the block room
9. Please verify the identity of the patient and do the time out with the faculty.
10. Please verify about the NPO status, allergies, the site and side of the surgery.
11. Please mark the site and the side for the surgical procedure
12. Place and IV, and monitors like EKG, Pulse Oximeter and blood pressure monitor and record the baseline vital sigs.
13. Administer judicious IV sedation.
14. Please prepare the area and drape it in a sterile fashion.
15. If you plan to use the nerve stimulator, please make sure it is grounded
16. If you plan to use the ultrasound probe make sure it is the right frequency probe and the sterile sleeve and the sterile gel are available
17. Please document the details for the block on the block form
18. Transfer the care to the anesthesia team assigned to that patient
19. Give a copy of the block form to the coder for billing
20. Place an ultrasound picture of the block in the patient's record

EXCELLENT TEAM WORK AND MENINGFUL COMMUNICATION WILL ASSURE THE SUCCESS AND EFFICIENCY. THIS WILL RESULT IN EXCELLENT CLINICAL CARE AND SATISFIED CLINETELE

Types of blocks

Most common blocks we will perform during this rotation are

1. Brachial plexus block
2. Lumbo-sacral plexus block
3. Paravertebral block
4. Transverse Abdominis Plane (TAP) block

Brachial Plexus Block

This can be done using

1. Interscalene approach
2. Suprclavicular approach
3. Infraclavicular approach
4. Axillary approach

1	What peripheral nerve block has the highest rate of complications a) Interscalene block Your answer has been saved.

2	Ulnar is the nerve that is missed with the interscalene block a) True b) False Your answer has been saved.

Lumbo-sacral Plexus Block

This is done using

1. Lumbar plexus block
2. Femoral nerve block
3. Fascia Iliaca block
4. Sciatic nerve block
5. Popliteal nerve block

Paravertebral Block

This can be done either unilaterally or bilaterally for

1. Mastectomy
2. Cholecystectomy
3. Inguinal hernia repair
4. Nephrectomy

Transverse Abdominis (TAP) Block

This can be done unilaterally or bilaterally

1. For inguinal or umbilical hernia repair
2. Total abdominal hysterectomy