ROTATION: FSC Regional Anesthesia (FSCR) 
TYPE: Elective CA-3 Level Rotation, Advanced Clinical Track Only
DURATION:One month
FACULTY:  F. Kayser Enneking, MD (FSCR) 
PREREQUISITES: Completion of clinical base year plus two years of clinical anesthesia 

GENERAL GOALS 

  • To teach anesthesia residents the art and science of regional anesthesia and its use in the ambulatory setting. 

SPECIFIC COMPETENCIES:  (General Competencies and FSC Competencies also apply)

PATIENT CARE SKILLS:

  • Be able to appropriately select patients for regional anesthesia, recognizing patients that will do better either with general anesthesia or with a combined regional / general technique
  • Rational selection of regional anesthesia technique and choice of local anesthetic for particular patient encounters. 
  • Properly and efficiently and independently perform blocks for the operations on the extremities
    • Upper: axillary, interscalene, and infraclavicular brachial plexus blocks; less commonly, median nerve and ulnar nerve blocks
    • Lower: femoral, obturator, lateral femoral cutaneous, popliteal, sciatic and ankle blocks 
    • Intravenous regional anesthesia
  • Ability to assess adequacy of regional anesthesia before the start of surgery, and demonstrate appropriate plans for supplementation of inadequate blocks. 
  • Provide effective anxiolysis and sedation of patients by both pharmacologic and interpersonal techniques. 
  • Select appropriate monitors for specific patient encounters, and document performance of regional anesthetic adequately. 

MEDICAL KNOWLEDGE:   (See also General Competencies)

  • Know general principles of local anesthetic pharmacology, including the pharmacodynamics and pharmacokinetics of various local anesthetics. This includes onset, duration, motor/sensory differentiation, and toxicity profile of various local anesthetics. 

  • Know the principles and indications for various local anesthetic adjuvants including: Epinephrine, sodium bicarbonate, carbonation, alpha-2 agonists.  

  • Be familiar with the relevant anatomy for peripheral nerve blocks, including upper and lower extremity anatomy. 

  • Be familiar with the physiologic changes associated with high local anesthetic levels.

  • Understand the indications for and the contraindications to regional anesthetic techniques in the ambulatory setting. 

  • Understand the anatomy, pathophysiology, and appropriate management of complications and side effects of regional anesthetic techniques including: 

  • Local anesthetic complications - toxicity and its treatment

  • The use of test doses

  • Nerve Injury and its prevention

  • Pneumothorax - assessment and treatment

  • Sympathectomy, phrenic nerve block, intercostal nerve block, peripheral nerve injury

PROFESSIONALISM, INTERPERSONAL AND COMMUNICATION SKILLS, PRACTICE-BASED LEARNING and SYSTEMS-BASED PRACTICE:  See FSC Competencies

EVALUATION TO DETERMINE GOAL ACHIEVEMENT 

  • The resident should have developed a plan for pre, intra, and postoperative anesthesia care to be prepared to discuss the case with the attending anesthesiologist. Part of the evaluation will be based on these preoperative discussions. 

  • Attending evaluation of daily clinical performance in the operating room in the following areas: 

  • Preparation for the case and ability to carry out plan discussed preoperatively at FSC, including the rational choice of regional technique and local anesthetic. 
  • Recognition of problems and communication with the attending, including the use of supplementation and sedation, toxic reactions, tourniquet pain, and changes in volume status. 
  • Technical skill during the placement of the regional block.

  • Each attending you work with will evaluate you weekly with the Departmental online evaluation form. This form specifically addresses different regional anesthetic techniques and your competency for your level. This form is reviewed quarterly by the Clinical Competence Committee and continuously by the program director.  Your advisor will inform you of any problems identified. Any serious problem will be discussed with you immediately after it occurs.

  • The Program Director will evaluate the results of the In-Training Examination for the American Board of Anesthesiologists (ABA) in general and for areas of departmental weakness. Consistent weakness may result in adjustment of the above goals.

 TEACHING RESOURCES TO ACCOMPLISH THE OBJECTIVES

  • Approximately 150 elective Orthopedic cases per month including the following; Foot and ankle, knee, hand, shoulder, and uncomplicated oncology.  There are cases performed in patients of all age ranges, from the the very young to the oldest of the old.

  • Regional anesthesia workbook provided by the department.

  • Compendium of Regional anesthesia provided by ASTRA. 

  • Regional anesthesia block lectures.

  • Reference List of pertinent articles. (see Classic Anesthesia Articles Library - Regional Anesthesia Section)) 

  • Multi media resources available include Regional Anesthesia interactive CD rom available in the Resident Library. A film library is available to any resident interested in particular techniques.

  • Faculty members: 

    • Larry Berman, MD
    • Kayser Enneking, M.D., responsible faculty member
    • Jill Freedman, M.D.
    • Brian Ilfeld, M.D.
    • Tim Morey, MD
    • Rich Rogers, MD
    • Sno White, MD 

 

RETURN TO INDEX FOR GOALS AND OBJECTIVES
Revised 6/2005