A Day in the Life of a Duke Anesthesiology Resident

Neil Hanson, MD, CA-3 Resident

CA-3 Regional Block Rotation

The Duke North Block rotation shares similarities with the ASC rotation; in so far as there is an emphasis on perfecting your regional anesthetic techniques. This rotation is exclusive to CA-3 residents; however, because of the mastery necessary to perform and teach the blocks. It is an anticipated rotation in the career of the Duke resident; as it puts you in a position of leadership not only with junior residents but also other attendings that are not so familiar with nuances of regional anesthesia.

A typical day begins at 6:00 AM when we arrive in the Pre Operative Holding area to set up the block cart for the day. By 6:30 AM, we will begin to see patients in the pre-op holding area in order to discuss the anesthetic plan for their respective surgeries. Because the rotation is intended to be a strict practice in regional anesthesia, we are only responsible for seeing patients who will require a neuraxial or peripheral nerve block. During the rotation, we not only have the opportunity to perform single-shot and continuous peripheral nerve blocks (interscalene, supraclavicular, axillary, infraclavicular, femoral, saphenous, popliteal, sciatic, and lumbar plexus), but also to teach the appropriate techniques to new learners.

The sicker patient at Duke North also provides us with a great range of clinical scenarios to practice our techniques upon. Truly understanding the indications and contraindications for regional anesthesia is one of the cornerstones of this rotation. After completing the block and confirming its onset, we usually move onto the next one. If there is time between blocks, then we can help a junior resident transport the patient back to the operating room and help them get the surgical case started.

Unlike the ASC rotation; where there is a dedicated resident in the PACU, we generally do not follow patients in the postoperative period unless a block has failed. In this instance, we are responsible for assessing this patient’s needs and performing another regional anesthetic if it is indicated. The day ends around 4:00 PM, after the last scheduled patient has gone to the operating room.