Regional Anaesthesia systems

Regional anaesthesia administered by a trained anaesthetic professional, with or without sedation, can be deployed in a number of ways. Its use can greatly enhance both patient experience and efficient theatre flow.

A patient information leaflet has been produced by the Royal College of Anaesthetists in 2015 (1st edition), and a copy can be found here.

Block techniques:

The commonest upper limb blocks used for hand surgery are axillary and supra or infra clavicular. Brachial plexus and peripheral nerve blocks are now usually administered using ultrasound guidance. This allows accurate and effective delivery of anaesthesia to the nerves while significantly reducing the risk of nerve injury.

Many patients find it difficult to have a fully anaesthetised and flail arm for long periods post operatively. A growing number of anaesthesia professionals use a short acting proximal block combined with longer acting peripheral nerve blocks. The proximal block providing anaesthesia for the procedure (including tourniquet cover) and the peripheral blocks giving good post-operative analgesia. This technique is especially useful for bony procedures.

Using a block room:

A specific space is set aside for pre-operative patients to receive their block. This is often within the theatre suite and is staffed by an anaesthetist or anaesthetic associate (AA) supervised by an anaesthetist and an operating department practitioner (ODP).

A block room allows patients to be anaesthetised in advance so that their regional block is fully effective prior to surgery without blocking the theatre or anaesthetic room. The patient waits in a monitored but calmer environment than the areas closer to the theatre.

Overlapping cases:

In many organisations the anaesthetic/theatre teams are able to care for one patient in theatre, with an effective block, coming towards the end of their procedure and another in the anaesthetic room having their block administered. Often the escort who brings the patient from the ward/day unit (either a member of the ward staff or theatre team) will remain in the anaesthetic room with the patient to assist with the block and keeping the patient company while they wait for it to take effect and the theatre to be ready for them.

Both of the above are methods to enhance patient flow through the theatre suite. While they can be highly effective with anaesthetists alone they are often made more efficient by using AAs, often at a ratio of 2 AAs to each supervising consultant anaesthetist.

AAs involved in hand surgery services will often become highly skilled in regional anaesthesia techniques. This is beneficial for the patients as they receive quality care but also for training as the AAs can support the skill acquisition and mastery of anaesthetists in training.