Ultrasound Guided Regional Anaesthesia

1. Ultrasound Guided Regional Anaesthesia • Can you DIY? James Lai Auckland City Hospital

2. Disclosure of equipment support

3. Can one safely train oneself in USGRA ? YES • Why do we need a prescribed course of training and minimum set of standards for USGRA ? For the benefit of patients and the speciality of regional anaesthesia

6. Training registrars - regional anaesthesia is a “clinical fundamental” in the curriculum redesign • Certification • Accreditation

19. Key Concepts • Time • Place • Person

20. The more time the better....

27. Key knowledge and skills • Ultrasound physics and knobology

29. Select Probe Select Preset Select DEPTH and RESOLUTION Select 2D Adjust GAIN CPD Doppler

30. Key Skills • Ultrasound physics and knobology • Sonoanatomy - image optimisation and interpretation

32. Anisotropy

33. Key Skills • Ultrasound physics and knobology • Sonoanatomy - image optimisation and interpretation • Needle imaging

34. Needle Imaging • Long axis(in-plane) • Needle aligned with US beam • Excellent needle definition (shaft & tip) • Safe when used correctly • Short axis(out of plane) • Needle crosses US beam • Limited needle definition • Needle tip may be “beyond” US beam

38. Safety First! • Start with a simple blocks • In-plane needle imaging • Don’t advance unless you see the tip • Use hydrodissection and maintain good needle visualisation • Inject outside the nerve and observe spread

41. Do we need a prescribed course of training and minimum set of standards for all US users ? • Or can one safely train oneself in USGRA ? (DIY)

42. Next Meeting BATS on ice Queenstown 25th August 2011