Regional Anesthesia

By the end of my regional anesthesia rotation, I felt very confident doing most of the standard blocks. I understood the anatomy of the brachial plexus and the lower extremity nerves, became facile with the ultrasound, and developed reasonable skill for finding a nerve, putting a needle next to it, and numbing it up. It's actually quite fun and satisfying as the results are immediate, and the benefit for patients significant. By providing good post-operative analgesia and in some cases avoiding general anesthesia, we could really improve the patient's experience with orthopedic surgeries.

The problem is that unless I continue to practice nerve blocks, it is something that fades with time. Everything in medicine is like this; if you were to ask me the current guidelines for cholesterol management or how to deliver a baby or how to read a CT scan, I'd be quite rusty, though they are all things that I've learned in the past. This is the challenge of regional anesthesia; we either have to make it something we do regularly or we have to live with the fact that we will never be experts.

Rest assured, it's not a hard skill. After spending several years in medicine, I've realized that putting a needle into a target is not all that difficult. But doing so efficiently and understanding the nuances and risks are a little more tricky. I don't envision myself blocking people day after day, but this rotation has given me the confidence to broach regional anesthesia in the future if I feel that it is best for the patient. For example, it is useful to have in the toolkit in international medicine where general anesthesia is riskier and pain medications more scarce.

The rotation as a whole was a steep but wonderful learning experience. I did upwards to a hundred blocks in four weeks, and learned not only the technical skills but also the systems issues regarding regional anesthesia. I was thrilled by how my patients did. I was frustrated by the paperwork. I came to understand a whole new facet of anesthesiology.