Throughout their training, residents will have many opportunities to learn how and when to use regional techniques for anesthesia and analgesia in obstetrics, pain management, and thoracic surgery, but the regional rotation is used to specifically teach regional anesthesia. This rotation was actually brought about after residents expressed an interest in learning more regional techniques during their residency. The administration responded by starting a rotation dedicated to placing regional blocks for intra-operative anesthesia and post-operative pain management. The residents' hard work convinced many of surgeons in orthopedics and plastics to change their surgical management and request blocks for many of their important surgical procedures.
As a resident, you complete a required regional rotation as a CA-2 and are given the opportunity to do an elective rotation as a CA-3. If you are scheduled as the "Block Resident", you spend the day placing regional blocks for all the patients on the East campus. Most of these blocks are done under ultrasound guidance with one-on-one attending supervision. To offer the most time to establish your skills at regional anesthesia, you are not scheduled for any OR cases on your block days. This is one of the most popular senior rotations. Additional regional block experience is obtained on the West campus when residents rotate on the acute pain service. The busy orthopedic trauma service creates opportunity for catheter-based regional techniques.
A Day in the Life
"During the regional rotation residents get exposure to a wide variety of peripheral nerve blocks during their CA-2 year, as well as their CA-3 year if they chose to do another month. The vast majority of blocks are concentrated as either upper extremity or lower extremity nerve blocks, with a few other outliers such as TAP and Paravertebral blocks. All of our blocks are performed with the aide of the ultrasound machine, so residents become very proficient at using the U/S for performing peripheral nerve blocks. Since we have two campuses at BIDMC, some days are spent on the East Campus (mainly ambulatory surgery), and other days are on the West (Ortho trauma and more advanced cases).
On a typical day on East, the resident will perform anywhere between 8-12 blocks on average, while on the West the resident will perform anywhere between 4-8 blocks on average. In addition to single shot nerve blocks, we also will occasionally insert peripheral nerve catheters (mainly upper extremity). Also, occasionally residents will aide in placement of epidurals (thoracic and lumbar) for specific abdominal or thoracic procedures. In addition to the regional rotation, residents will rotate on the Acute Pain Service and have a few days of regional experience and learning how to manage peripheral nerve catheters. Overall, we have a very strong regional program at BIDMC and residents by the end of their rotation on CA-2 year are technically proficient and comfortable with performing ultrasound guided peripheral nerve blocks." - Fernando Mujica, CA-2