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Advanced Module in Regional/Ortho Anaesthesia

Sunderland Royal Hospital

Regional anaesthesia at Sunderland is based in a block room environment which is nationally recognised as a leader in the field. Advanced regional trainees are instructed by a dedicated team of 8 block room consultants.

As an advanced regional trainee at Sunderland, you will gain extensive clinical experience of a wide range of regional anaesthesia procedures for both awake and asleep surgery. As a team, we perform around 1500 blocks in any six month period and most advanced trainees can expect to get over 400 procedures. Specialist trainees rapidly gain experience, using the latest generation SonoSite X-Porte system. Our block room system allows trainees to benefit from performing a large number of blocks (including catheter techniques) over a concentrated period.

Non-clinically, trainees have the opportunity to gain management experience by leading the block room team and to contribute to innovation as part of our on-going programme of regional anaesthesia projects. All recent trainees have been able to present posters at national meetings, been given the opportunity to lead local education sessions and have become involved with national meetings. Dr Nat Haslam is co-lead for the University of East Anglia Diploma in Regional anaesthesia and a member of RA-UK council. A number of the other consultants teach on national regional anaesthesia courses and examine for the Diploma.

Further information, contact:

Dr Nat Haslam,

Advanced trainee module lead,

RA-UK Council Member

Royal Victoria Infirmary

The RVI is a large tertiary referral centre in the centre of Newcastle upon Tyne. Of particular important is the fact this is a major trauma centre which also houses one of the most progressive regional anaesthesia departments in the UK.

We have approximately 20 consultants and SASG doctors who provide a full range of regional anaesthesia techniques. A subset of these individuals are involved in the running of the NUSGRA organisation and website (www.nusgra.co.uk), which provides educational materials in regional anaesthesia, as well as running two national cadaveric ultrasound courses per year.

We have a well-established block room in the day case theatre area, where awake surgery is the standard of care for elective hand and wrist surgery as well as all plastics hand trauma. Additionally, this area is also utilised for the insertion of nerve catheters for a variety of indications, mainly trauma but also for prolonged analgesia for inpatient physiotherapy.

Scope of work

The RVI provides the majority of adult and paediatric surgical services, exceptions being cardiothoracic surgery, transplant, vascular, urology and elective hip / knee arthroplasty, which are undertaken at our partner site, the Freeman hospital.

Regional anaesthesia is widely employed around the RVI in many specialties, including orthopaedic trauma, shoulder, breast, and plastic surgery including major free flaps as well as hand surgery. We work very closely with our acute pain team to innovate and expand the remit of regional anaesthesia. With regards to nerve catheters for trauma patients, in a 12 month period we placed 154 paravertebral and 300 fascia iliaca catheters, in addition to smaller numbers of erector spinae, femoral, interscalene and supra/infra clavicular catheters. These figures do not include catheters placed for elective surgery.

Since 2012, we have run an awake shoulder surgery list every week for high GA risk patients, employing interscalene catheter infusions which patients are discharged home with on the day of surgery. This pioneering service has revolutionised high risk open shoulder surgery in our region, and was shortlisted for a National award. We also offer awake breast surgery to high risk patients on a case by case basis.

In addition to this, we can offer a multitude of non clinical opportunities for our advanced trainees in regional anaesthesia:

Teaching – we teach on local courses as well as running national NUSGRA cadaveric courses. We were selected as a centre to hold the RA-UK / ESRA E-day in January 2018, which we will be repeating next year, and we will continue to provide faculty for the national SonoUK Festival of Ultrasound, which held its first course in April 2018.

Publications – the regional anaesthesia department actively contributes to peer reviewed journals with contributions in original research, case reports, technical reports and letters of opinion. We are soon to submit a manuscript highlighting our experience of paravertebral catheters techniques for chest trauma, of which we perform more than any other UK site.

Research – We are actively pursuing funding to undertake original research in the role of and effectiveness of regional anaesthetic techniques in breast surgery.

Service development – A business case is in progress to set up a second block room to service orthopaedic / trauma theatres and to provide an alternative location to undertake catheter techniques for acute pain and trauma.

Innovation – We have recently incorporated spirometry into a novel scoring system for chest trauma patients, and there is opportunity to further develop the clinical pathway for these patients and to undertake audit or research in this area. Furthermore, we are one of only a few sites where anaesthetic assistance are encouraged to undertake ultrasound guided infrainguinal fascia iliaca blocks in hip fracture patients. This service depends on us delivering the set teaching program, as well as running a cadaveric course specifically configured to teach fascia iliaca blocks. We embrace new technology and there are opportunities to be involved in the creation of new online learning materials and to help create and develop newer ways of connecting with our patients, an example being the recent adoption of patient SMS messaging services.

DUTIES

POST

This six month post is available to anaesthetic trainees on the Northern Deanery Rotation in Anaesthesia who are in possession of the FRCA.  Trainees are expected to complete higher regional anaesthesia competencies before applying for advanced regional anaesthesia placement. The post will be for 6 months to dovetail with the training rotation.

This EWTD compliant post will involve night shift work on weekdays and weekend shifts.

It is anticipated that the Advanced Trainee in Regional Anaesthesia will gain a broad and unique experience in all aspects of surgery requiring regional anaesthesia.

For further information please contact the clinical lead for Regional Anaesthesia at the RVI, Dr Jonathan Womack.

Last updated July 2018

Author: Dr Adnaan Qureshi

Queen Elizabeth Hospital, Gateshead

Module lead:      Dr Ash Gupta

The advanced module here is run as per the RCoA curriculum guide for Regional Anaesthesia.

We endeavour to provide trainees with the maximum clinical exposure in terms of numbers and types of nerve blocks and experience of running of RA lists, including the supervision of more junior colleagues.  In addition to multiple upper and lower limb lists, there are regular awake shoulder surgery lists.  We also provide exposure to PECS blocks for breast surgery, and abdominal wall blocks including Quadratus Lumborum and Rectus Sheath bocks for general surgery.

We are increasingly using catheter techniques for post-operative analgesia, and as per the latest evidence we have started siting adductor canal catheters for knee arthroplasties.

In addition to clinical exposure trainees are guided and helped to complete a project (audit, survey or Quality Improvement Programme) to be presented at national or international meeting  e.g. RA UK  / ESRA / ASRA meetings.

During the latter half of the Advanced Module there would be opportunity to help in the formal and informal teaching of regional anaesthesia.

There would also be opportunity to publish depending on the time and commitment demonstrated by the trainee.

The feedback from the past advanced / higher and intermediate trainees has been very positive.

“I have really enjoyed my time here at QEH Gateshead. I had good relationship with all consultants in the department I worked with. I had excellent experience in advanced regional anaesthesia and orthopaedics and exposure to advanced domain training including management, education, leadership and general clinical management of patients with very minimal supervision. In fact I would be very happy to come back here and join the department as a consultant.”

Trainees within the department have been able to contribute to a number of presentations in the past three years:

International Presentations

  1. Bradycardia/Hypotension during awake arthroscopic shoulder surgery in the sitting position after Interscalene block: Case report and series of 19 cases with literature review. S.M Ghosh ST7 Anaesthetics, A. Gupta Consultant Anaesthetist Queen Elizabeth Hospital, Gateshead, UK

32nd Annual European Society of Regional Anaesthesia & Pain – ESRA 2013

  1. Audit of Quadratus Lumborum block: A novel analgesic method for major abdominal surgery. J Anto, S Hamza, A Kansal, S Narayanan, L Swan

15th World Congress on Pain, 2014 – Buenos Aires

  1. Setting up regional anaesthesia service for awake arthroscopic shoulder surgery in a DGH – Challenges, our experience and the future. Dr A Aggarwal, Dr A Gupta Anaesthetics Northern Deanery & Queen Elizabeth Hospital, Gateshead, United Kingdom

34th Annual European Society of Regional Anaesthesia & Pain – ESRA 2015

  1. ‘Stop before you block’ Accepted for presentation

35th Annual European Society of Regional Anaesthesia & Pain – ESRA 2016

National Presentations

  1. Case report – Diagnostic shoulder arthroscopy and open repair of rotator cuff in a patient with confirmed malignant hyperthermia under interscalene brachial plexus block and sedation. Bird R, Gupta A, Chakravarthy J, Meikle S,  Queen Elizabeth Hospital, Gateshead, UK

RA-UK Annual meeting, 2014

  1. Analgesia for shouder surgery: Peineural dexamethasone improves patient satisfaction. RG Mudimadagu S Hamza, Queen Elizabeth Hospital, Gateshead, United Kingdom

RA-UK Annual meeting, 2014

 

Regional presentation

  1. Setting up regional anaesthesia service for awake arthroscopic shoulder surgery in a DGH – Challenges, our experience and the future. Dr A Aggarwal, Dr A Gupta Anaesthetics Northern Deanery & Queen Elizabeth Hospital, Gateshead, United Kingdom

NESRA annual meeting, 2015

Freeman Hospital

Module Lead:                                        Dr. Martin Jones 

The Freeman specialises in complex major surgery including major vascular, orthopaedics, hepatobiliary and intra-abdominal transplant surgery (liver, pancreas, kidney & kidney /pancreas transplantation), plus colorectal, urological, and ENT/Maxillofacial specialities. As part of our commitment to provide outstanding peri-operative care, we have a recently established block room service to provide regional anaesthesia to our patients.

Trainees undertaking an Advanced Module in regional at the Freeman can expect to undertake approximately two hundred ‘single shot’ peripheral blocks of all types as part of peri-operative care for upper and lower limb orthopaedic and vascular surgery. Also, the Advanced Training Module in Regional Anaesthesia at the Freeman Hospital provides opportunities to acquire clinical skills in advanced regional anaesthetic techniques. At the Freeman we provide a peri-neural catheter service which was recently shortlisted for a national award, plus additional catheter techniques for peripheral and central/neuraxial nerve blockade. We would expect trainees to become proficient in these skills with approximately four-hundred patients receiving a peri-neural or fascial plane catheter every six months. Additionally there would be opportunity to develop experience in management of awake-surgery lists for vascular access and exposure to other advanced regional techniques such as truncal/abdominal blocks.

There are a multitude of professional development opportunities on offer during our advanced module, including access to projects covering QI, education, management and research. As part of their Advanced Module, trainees would be supported in the expectation of contribution to these projects as part of their requirement to provide evidence for Annex G of the training curriculum, and to help prepare the successful applicant for a future career as a Consultant Anaesthetist with a specialist interest in Regional Anaesthesia.

Northumbria Healthcare Trust

With the appointment of new consultant orthopaedic surgeons who undertake major spinal and pelvic surgery, we are now able to extend our popular regional advanced training module to include orthopaedics.

It is expected that trainees will have a degree of proficiency in some of the more common regional blocks and this will be consolidated by spending supervised time in the block rooms across all sites.  As experience progresses, it is expected that the trainee will undertake teaching of regional anaesthesia to less experienced colleagues and begin to work with more autonomy to gain experience in block room management and list organisation and coordination.

Trainees will also be given the opportunity to develop more independent practice in complex orthopaedics including complex joint revisions, spinal (cervical and lumbar, anterior and posterior approaches) progressing to supporting junior colleagues on these lists.  As many of these patients will attend for consultant pre-assessment, trainees will be able to attend these sessions to improve their abilities in planning and coordinating care for patients undergoing complex surgery across a multi-site organisation.

They will also be given the opportunity to attend multi-disciplinary and relevant management meetings.   It is expected that the trainee will undertake and present a quality improvement or management project during this time.

Trainees will be expected to work with a higher degree of autonomy and to participate in the teaching training and supervision of more junior trainees.   In addition, trainees will be supported in developing their non-technical skills in preparation for the consultant role.

Darlington Memorial Hospital

Please find attached the advanced module guide for regional anaesthesia

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