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Statement of Need

Within the clinical specialty of anesthesiology a strong interest in peripheral nerve blockade has continued to develop over the last decade. An increase in the availability of handheld ultrasound devices has fueled this interest, leading to a need for training in procedures that regional anesthesia caregivers may be unfamiliar with providing. The American Society of Anesthesiologists (ASA) and the American Society of Regional Anesthesia (ASRA) now offer an increasing number of dedicated ultrasound-guided regional anesthesia workshops, in which many of the faculty from the Regional Division in the Department of Anesthesiology at Duke have participated as instructors.

The venues for these conference workshops, typically hotel function rooms, preclude the use of cadaveric tissue with which to demonstrate the relationship of the pertinent nerves to adjacent tissues and structures. It is well recognized that this “hands-on” cadaveric teaching helps to emphasize the participants’ understanding of anatomy, and with correlation using ultrasound devices, allows improvement of the clinical skills required for successful nerve block placement.

The opportunity for anesthesia residents, nurse anesthetists, and practicing physicians to encounter cadaveric dissections is very limited. The majority of resident training programs do not offer anatomy education in the gross anatomy lab, and for practicing physicians and CRNAs, access to anatomy labs is limited.

The Human Fresh Tissue Lab at Duke is a dedicated facility using fresh tissue specimens, in contrast to formalin-preserved cadavers. The color and texture of the tissue is far better preserved permitting clear identification of anatomical structures and differentiation of nerves from adjacent tissues.

Target Audience

This activity is designed to educate or refresh the knowledge of practicing anesthesiologists, critical care specialists, and certified registered nurse anesthetists (CRNAs) in the anatomical requirements, techniques, and side effects of ultrasound-guided regional anesthesia and peripheral nerve blockade.

Learning Objectives

At the end of the workshop, the registrant will be able to:

1. Recognize and describe the anatomy of the peripheral nervous system (brachial, lumbar, and sacral plexuses and their terminal branches).
2. Correlate neuroanatomy and regional anesthesia techniques for both upper and lower extremities to provide nerve blocks.
3. Use an ultrasound device in order to visualize nerves and surrounding structures at the common sites for nerve blockade.
4. Discuss the side effects and complications of nerve block techniques and relate these to the proximity of related anatomical structures.
5. Recognize the signs and symptoms of local anesthetic toxicity and describe the appropriate clinical management.