Ether, do you still do retrobulbar blocks or did you switch to peribulbar?
Remember, I have been in practice for quite a while and I supervise a lot of cases. My First 12 years in practice I covered the ICU and the entire hospital at night and on the weekends. During this time I averaged 6-9 Central lines a day. That's right, a day! I probably have done more than 15,000 during more career. I don't care whether you believe me it's the truth.
I no longer cover the ICU so my central line numbers are only 2 per day. The hospital hired Intensivists (finally) and these guys do most of the ICU/Floor central lines these days.
I have personally done more than 4,000 interscalene blocks and at least that many Femoral blocks. I am now doing Infraclavicular blocks and have quite a few of those as well. I have done the axillary technique transarterial, two nerves, three nerves and all the nerves with a stimulator. My experience agrees with the literature in published success rate except my transarterial is about 95%. Interscalene 99.5%, Femoral 99.5%, Infraclavicular (double stimulation) 95%, Lumbar Plexus 99%.
With experience and volume (lots of volume) you will get better. I work in a high volume practice with tons of cases. My hospital does abour 20-25 totals per week. Ortho is huge in my facility.
As for eye blocks, I prefer topical MAC. But, a few of the older eye surgeons still insist on an "immobile" eye and peri-bulbar just doesn't cut the mustard.
A sub-tenon's block works well but why should I start doing those for $75 Medicare cases? I learned Retrobulbar blocks to make the eye surgeons happy. This way they get two rooms and don't have to bother with the block. Most of the young MDA's don't have any interest in the technique these days.
My average supervision/solo case load per year is 3500. Many years I break 4,000 cases per year. That is the kind of volume that should make you rock solid clinically. The average "solo" MDA does 1,000-1,200 cases per year.
