Programs w/ regional

[m3unsure]

---

Members don't see this ad.

Hey everyone,

After being on the interview trail, which programs stick out when dealing with regional anesthesia? Let's say at least 1-2 months devoted to blocks.

And then, which places suck even if they have a big name?

I ask cuz I think that this is the future at least for outpatient stuff so being good at it is definitely helpful.

 

[OffPiste]

Places the come to mind right off the bat:

1. U. Pittsburgh
2. Hospital for Special Surgery (I think Cornell affiliate)
3. Hopkins

All have big names in the field and residents graduate with up to several hundred blocks. More importantly, in my opinion, see which places are incorporating U/S heavily into the regional program as this will likely be the standard of care in the next 5-10 yrs.

If you are on the interview hunt, be discriminating about a program's regional experience, and do not be afraid to ask pointed and tough questions about the issue.

 

[VolatileAgent]

our program does. we also have a regional fellowship. you may not get to do "hundreds" of blocks during residency, but it will be several dozens. and, if you do the fellowship, you'll get into the hundreds numbers.

 

[militarymd]

Here's my take on regional...

No apparent standards....despite what each "guru"...many of whom I've spoke with and watched.....will tell you.

Each institution will do things very differently...

and ultimately...it will be different from where you practice....

when I say different...I mean:

- type of local..
- concentration of locl
- volume of local
- timing of blocks
- location of blocks
- monitoring of blocks
- etc. etc. etc.

And it doesn't matter how many blocks you do....some people just DON'T have it....per other thread....

so I would worry less about the name of the program ...more on the OPPORTUNITY to learn basic technique and anatomy...unless you specifically have a JOB in mind that requires you to train at one of the BIG names...those jobs...usually will tell you where you need to train.

President
SARA (society against regional anesthesia)
reluctantly ...providing pain free post operative courses for my TKA's and other pain producing orthopedic procedures.

 

[pmichaelmd]

Hey everyone,

After being on the interview trail, which programs stick out when dealing with regional anesthesia? Let's say at least 1-2 months devoted to blocks.

And then, which places suck even if they have a big name?

I ask cuz I think that this is the future at least for outpatient stuff so being good at it is definitely helpful.

I love doing regional and am fortunate to be at a program that does a lot of it. I think we have a pretty strong department in Drs. Roy Greengrass and Steve Clendenen. The former is a person who has written many articles and described some of the original techniques while with Winnie in Canada and later at Duke. We are lucky to have him.

As far as volume, we have plenty of it. While we don't have a regional fellowship in place yet, I can tell you that I've done 3 months of dedicated regional anesthesia and have placed 480 peripheral nerve blocks, at least half of which with catheters. I am not including epidurals and spinals in this number, just peripheral nerve blocks. We do ankle, popliteal, sciatic, femoral, psoas, paravertebral, axillary, infraclavicular, and interscalene blocks routinely, all (except ankle, of course!) with catheters as the need arises. We are just starting to use ultrasound and recently did the first 3D ultrasound PNB. I don't know how applicable this will be as it is time consuming, but we get pretty good with the stimulater. We also have stimulating catheters. I am going to do 1 more month of regional as I am going to be doing regional for my group in July, so I expect to have over 600 PNBs by the time I graduate.

I know there are several centers that also do a good amount of PNBs (St. Luke's/Roosevelt in NYC (the NYSORA group), Cleveland Clinic, Virginia Mason, Duke) but I don't know any that do more than we do. Keep in mind that we are a small program with only 4 residents per class.

I have to admit that I love doing regional, but it's not for everyone.

Cheers,
PMMD

 

[Lizard1]

I've done 3 months of dedicated regional anesthesia and have placed 480 peripheral nerve blocks, at least half of which with catheters.

that sounds like a great opportunity...i only got to do about 5-10 peripheral nerve catheters at Emory

 

[Mista Suprane]

Iowa

 

[smgilles]

From my own interviews I thought those who were stronger in regional were:

1. Mayo
2. Iowa
3. UPMC

I also thought PSU and CCF had potentional, but weren't near strong as the 3 stated above. Just my myopic view after a one day interview though.

 

[Bougie]

The question you should also ask on interviews is how educated and amenable the orthopods at the institution are towards regional techniques. You can have all the equipment, faculty, etc but if you have surgeons who frown at RA just because they have seen a complication or two it doesn't matter.

 

[morpheus md]

From my own interviews I thought those who were stronger in regional were:

1. Mayo
2. Iowa
3. UPMC

I also thought PSU and CCF had potentional, but weren't near strong as the 3 stated above. Just my myopic view after a one day interview though.

Duke also does a whole lot of regional.

 

[Varmit22]

I heard that one of the main regional guys at Iowa was taking a job in Florida so things may change there. But this was heard second hand so take it for what it's worth.

 

[Frank Rizzo]

The question you should also ask on interviews is how educated and amenable the orthopods at the institution are towards regional techniques. You can have all the equipment, faculty, etc but if you have surgeons who frown at RA just because they have seen a complication or two it doesn't matter.

This is probably the most important question.

 

[Dryacku]

I am really interested in UF do you know the name of the regional attending that is leaving?

I heard that one of the main regional guys at Iowa was taking a job in Florida so things may change there. But this was heard second hand so take it for what it's worth.

 

[Purpose]

Anyone heard anything about the status of the pain program at UF? I've heard its been on the verge of getting shut down. Any updates?

 

[Mapleson D]

From what I heard in all my interviews it seems that regional is on the up and up around the country. So many programs and residents said, "regional used to be our weakness, but it's improving a lot and we're doing a ton of blocks." Standouts for regional among the programs I interviewed at included Dartmouth and Virginia Mason (VM has been slow to jump on the U/S bandwagon but is using it now) and word on the street is that OHSU residents are doing more blocks/year than VM residents now.

 

[VentdependenT]

Duke
Virginia Mason

 

[burntcrispy]

Virginia Mason is supposed to be very good for blocks. I think that is what they are best known for.

If you're looking around Texas, Scott and White (Texas A&M) has excellent block training. They have an outpatient surgery center there and the resident does the blocks while the CRNAs babysit the pts in the OR. I forgot their stats but those guys got tons of blocks.

Wake Forest is supposed to be fairly decent as well.

 

[EtherMD]

Virginia Mason is supposed to be very good for blocks. I think that is what they are best known for.

If you're looking around Texas, Scott and White (Texas A&M) has excellent block training. They have an outpatient surgery center there and the resident does the blocks while the CRNAs babysit the pts in the OR. I forgot their stats but those guys got tons of blocks.

Wake Forest is supposed to be fairly decent as well.

Each Program's Regional Experience is only as good as those teaching it. Ask the Residents at the Program about their training and volume. Everyone needs basic blocks when finishing training and sufficient quantity. U/S guidance is fine but remember 3-D U/S is about 5 years away so current U/S machines will seem primitive by comparison.

A program that was good 5 years ago maybe average now if the Chairperson did not recruit good faculty. Similarly, a bad program 5 years ago may be great today. Find out the truth on the interview trail by asking the Residents.
In the end, it comes down to can you "walk the walk" and not just "talk the talk" with Regional. This means good success rate and the ability to do the block in no more than 10 minutes.

 

[mille125]

duke is the best for regional ......by far.....most CA-1 are in the 99 percentile nationally for number of blocks placed...(lumbar plexus, sciatic, paravertebral, interscalene, infraclavicular, supraclavicular, etc....)

 

[Pooh & Annie]

duke is the best for regional ......by far.....most CA-1 are in the 99 percentile nationally for number of blocks placed...(lumbar plexus, sciatic, paravertebral, interscalene, infraclavicular, supraclavicular, etc....)

I'd be willing to bet big bucks that Duke doesn't even do the most in North Carolina. I'd put my money on Wake.