Regional Anaesthesia

Countess of Chester Hospital

Contact: Dr Natasha Hettiarachchi (natasha.hettiarachchi@nhs.net)

Module Details: The aim of undertaking a Regional SIA at the Countess of Chester is to produce regional anaesthesia enthusiasts who will have the necessary knowledge and skills to develop the RA service in their chosen hospital during their future consultant career. In addition to developing toward independent practice of regional anaesthesia, they will have experience in the following:

• Who to block and how – Patient selection, pre-op consultation and education, gaining informed consent, safe approach to performing blocks, ergonomics and needling.
• Optimising the block – Approaches for analgesic blocks as well as anaesthetic blocks for awake surgery (both single shot and nerve catheters), block adjuncts, block rescue techniques.
• After the block – follow up of patients via the Acute Pain Service, managing complications.
• Learning to teach – there is a weekly RA program for trainees. A stage 3 trainee would be encouraged to bring their own ideas to develop the program and have a formal role in the delivery of teaching.
• QI and service development – some ongoing projects include for e.g. developing a block bay in theatre recovery and developing a sciatic nerve catheter insertion service for vascular patients awaiting revascularization/amputation. Stage 3 trainees would be mentored and allocated time to get involved in existing projects or to develop their own.

Our anaesthetic department is welcoming and teaching-oriented with a strong focus on regional anaesthesia. The department includes consultants who have undertaken a Masters in RA, the EDRA diploma as well as international fellowships in RA (in Australian and New Zealand) and trainees interested in these additional CV building opportunities would be well supported.

LUHFT (Royal)

Contact: Dr Penny Edmondson (penelope.edmondson@liverpoolft.nhs.uk)

Module Details: We perform regular regional anaesthesia for patients undergoing orthopaedic (femoral/saphenous/sciatic/ankle/brachial plexus) operations. We have an active pain intervention department where you can learn various peripheral nerve blocks (suprascapular nerve) and paravertebral injections. Awake brachial plexus blocks are performed for patients undergoing renal vascular access procedures, abdominal wall blocks for general surgery, chest wall blocks including Erector Spinae Block / Catheters for rib fracture patients and eye blocks for ophthalmic surgery. Trainees undertaking this module will have a chance to contribute to departmental teaching, encouraging the use of regional anaesthesia amongst colleagues. Time will be allocated for QI work. We are in the process of starting to use liposomal bupivacaine, which we hope to roll further out.

We would expect this module to be completed alongside the SIA in complex orthopaedics.

LUHFT (Aintree)

Contact: Dr Mike McGovern (michael.mcgovern@liverpoolft.nhs.uk)

Module Details: We perform regular regional anaesthesia for patients undergoing vascular and orthopaedic trauma operations. We have an active pain intervention department where you can learn various peripheral nerve blocks and catheter techniques. Trainees undertaking this module will have a chance to contribute to departmental teaching, encouraging the use of regional anaesthesia amongst colleagues. Time will be allocated for QI work.

Whiston Hospital

Contact: Dr Catherine Gerrard (catherine.gerrard@sthk.nhs.uk)

Module Details: At St Helens and Knowsley Teaching Hospitals NHS Trust, the scope for Regional Anaesthesia is significant. There are a broad range of surgical specialities based at Whiston and St Helens Hospitals which lend themselves to Regional Anaesthesia, including General, Plastics (including Trauma and Reconstructive), Burns, Ophthalmic, Urology, Orthopaedics with dedicated upper limb services, Orthopaedic Trauma, Day-case, Paediatrics, Gynaecology, Breast and Obstetric surgery. There is also a dedicated ‘awake surgery’ list for Plastics Trauma, where cases are managed exclusively under Regional Anaesthesia. The surgical team are eager to explore more avenues for awake surgeries and therefore welcome anaesthetic enthusiasm for Regional Anaesthesia. In order to consolidate knowledge and skills, supervision and teaching is provided by Regional Anaesthesia experts who are recognised both regionally and internationally. Trainees are encouraged to teach both within and outside the Anaesthetic Department. There is an established weekly Regional Anaesthetic teaching programme provided by Advanced Regional Anaesthesia Trainees. Future Advanced Regional Anaesthesia Trainees will be expected to continue to facilitate and develop this teaching programme. There will also be opportunities to get involved in regional and national teaching bodies and to build substantial networks within the speciality. There are Quality Improvement projects currently in place in the department. These welcome the involvement of Advanced Regional Anaesthesia Trainees e.g. the nurse-led fascia iliaca block pathway for fractured neck of femur cases, and the introduction of rectus sheath catheters for emergency and elective laparotomies. There is ample room for future developments in this area and Trainees are encouraged to bring their ideas to the department. Previous projects have included a retrospective review of two anaesthetic techniques used during laparoscopic bowel resection; intrathecal diamorphine vs Fentanyl-Ketamine-Lidocaine infusion. We see the Advanced Module in Regional Anaesthesia as a well-established and satisfying placement, despite the recent significant setbacks related to the Covid-19 pandemic. As and when it is safe to progress, we anticipate more opportunities for research and development and teaching and training and no doubt, placement within our department will bring several opportunities to prepare for a successful future as a Consultant in Anaesthesia. Other modules potentially able to be completed: Orthopaedics Previous trainee feedback: Module was in infancy, so took personal initiative. Excellent one to one teaching. Projects need to be manageable and realistic in timeframe. In Covid, when elective surgery was reduced, there was a strong focus on regional so this is a very useful and widely applicable skill.

Trainee feedback: Excellent one to one teaching. Projects need to be manageable and realistic in timeframe. In Covid, when elective surgery was reduced, there was a strong focus on regional so this is a very useful and widely applicable skill.

Warrington Hospital

Contact: Dr Zoe Apple (zoe.apple@nhs.net)

Module Details: Warrington Hospital offers orthopaedic surgery at two sites; the main Warrington hospital (mainly non-elective trauma surgery) and also at the Captain Sir Tom Moore Hospital. This is a purpose built elective hospital with four operating theatres, which is mainly used for elective orthopaedic surgery but which also performs breast surgery. We have a number of Consultant Anaesthetists with an interest in regional anaesthesia, who regularly perform awake surgery under upper or lower limb regional anaesthesia only. This module offers stage three trainees the opportunity to develop and refine their upper and lower limb regional anaesthetic techniques and to become confident in the management of lists delivered using solely regional anaesthesia. Other techniques, for example abdominal and chest wall regional anaesthesia, are routinely performed; either as analgesia for elective procedures (for example in breast and general surgery) or as part of an analgesic regimen for patients with rib fractures. We have successfully introduced erector spinae catheters which have been very effective in the management of pain in rib fracture patients. We hope to increase the number and range of peripheral nerve catheters undertaken and this would be an example of an area that a stage three trainee could make a significant impact through service development. As well as developing the leadership and decision making skills necessary to lead an operating list, we would expect trainees to lead a QI project of their choice whilst at Warrington. This project would be fully supported, with time allocated for data collection and to implement recommendations and also to attend and present at National and International Conferences. We are currently designing a Warrington regional anaesthesia course which aims to match the requirements of the RA-UK requirements for blocks for District General Hospitals. Trainees would be encouraged to deliver and develop this course further and also contribute towards two weekly departmental teaching programme and simulation sessions involving more junior trainees.

Arrowe Park Hospital

Contact: Dr Sharon Acheson (sharon.acheson1@nhs.net)

Module Details: WUTH offers a broad range of clinical experience in regional anaesthesia to both adult and paediatric patients. Opportunities include regional anaesthesia for upper and lower limb orthopaedics, vascular access lists under awake brachial plexus blocks, abdominal wall blocks for general surgery, chest wall blocks including Erector Spinae Catheters for rib fracture patients and eye blocks for ophthalmic surgery. Clinical opportunities provide cross links with other domains and capabilities. Trainees would be encouraged towards independent management and provision of safe and effective peri-operative analgesia through relevant ultrasound guided regional anaesthesia lists. There are opportunities to demonstrate leadership and organisational skills through organising and providing teaching to trainees through a weekly ultrasound guided regional anaesthesia teaching programme. We are proud to have hosted the national Arrowe Park Ultrasound Guided Regional Anaesthesia (APUSRA) Course on 12 previous occasions that has received excellent feedback. The trainee would have opportunities to get involved in organising subsequent courses. Trainees would be encouraged to bring their own ideas, engage with quality improvement work and development of guidelines. They would be encouraged to submit projects for presentation to national and international meetings related to regional anaesthesia (e.g. RAUK). Previous QI projects include formulating guidance on FICB for NOF fracture patients including teaching and training of the multi-disciplinary team. The trainee would be supported through further learning in EDRA exams if desired. This would be an excellent time of training to be involved in a welcoming and supportive anaesthetic department in preparation for a future consultant career.