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The Building Blocks of Regional Anesthesia

Updated: Oct 12, 2023

If you knew Dr. Alan P Winnie, then you knew his vision for regional anesthesia was

to see the practice evolve from the art that few had perfected to the science perfected and practiced by many. He believed that regional anesthesia would become a common discussion with patients as the choice for post operative pain management.

Valkyrie Simulators grew out of this same vision. We continue to be surprised that while so many advancements have been made over the past 2 decades, the number of blocks has not grown at the same pace as reported in this recent article written by Dr. Edward Mariano and published in Outpatient Surgery. This article reminds us that even with significant strides, propelled by innovations such as ultrasound guidance, much work remains to accomplish the transition from the art to the science for reginal anesthesia.

Under Utilized Experts in the field have been dedicated to perfecting nerve blocks and making them even more precise, with the ultimate goal of providing superior pain relief to patients. However, despite these advancements, regional anesthesia is not yet a common practice for most anesthesia providers. In outpatient settings, nerve blocks are utilized in a mere 3% of eligible surgeries, and even in cases where they could offer immense benefits, like shoulder arthroscopies, they are only administered 41% of the time.

Complexity Bias While the emergence of complex nerve blocks has given rise to a phenomenon referred to as the "complexity bias." This bias occurs when practitioners are daunted by these intricate techniques, leading to a hesitation to embrace regional anesthesia as a standard practice. To bridge the gap and promote the widespread use of regional anesthesia, this article takes a look at a back-to-basics approach. An essential step in this process is to ensure that every anesthesia provider is proficient in five fundamental nerve block techniques guided by ultrasound.

These fundamental blocks include:

1. Interscalene brachial plexus: A cornerstone for shoulder surgeries, delivering comprehensive pain relief for various shoulder procedures. 2. Infraclavicular brachial plexus: Essential for distal upper limb surgeries, versatile and highly effective. 3. Adductor canal: Ideal for knee surgeries, minimizing motor weakness and ensuring patient comfort. 4. Popliteal sciatic: Vital for foot and ankle surgeries, common in outpatient settings. 5. Transversus abdominis plane (TAP): The go-to choice for abdominal and pelvic surgeries, offering effective abdominal wall analgesia.


Enabling each anesthesia provider to master these fundamental blocks can revolutionize perceptions about the effectiveness of regional anesthesia. Standardizing the teaching and implementation of these techniques can eliminate barriers to their adoption and alleviate concerns related to patient benefits, practicality, liability, and cost. By improving research, sharing best practices, and increasing awareness of the benefits of these blocks, these obstacles can be effectively dismantled.

A gradual change and continuous learning promotes the transition towards widespread competency in regional anesthesia is an ongoing process, demanding evolving training and lifelong learning. Dr. Mariano goes on to stress the importance of providing improved simulation tools for experienced practitioners, allowing them to maintain and expand their skills effectively. By narrowing the range of block procedures that general anesthesia practitioners routinely perform, they can fine-tune their techniques and competence.

Furthermore, training should stress the highest level of care, including the ability to perform continuous nerve blocks with catheter insertion. This assures patients of control over their post-operative pain management, a pivotal factor in their overall comfort and satisfaction.

To genuinely elevate patient care and empower them with better pain relief options, it is imperative to boost access to regional anesthesia. This can be achieved through standardizing procedures, incorporating ultrasound guidance, and deploying advanced anesthetic delivery systems. Such measures will establish consistent techniques, ensuring practitioners can deliver effective continuous nerve blocks, solidifying regional anesthesia as a core competency for all anesthesia providers.

Conclusion The journey towards the widespread adoption of regional anesthesia is ongoing, but it is a transformative path that promises better patient outcomes and reduced dependence on opioids. Encouraging healthcare providers and training programs to embrace a back-to-basics approach, standardize essential blocks, and promote continuous learning can bridge the gap between experts and practitioners. Ultimately, this will transform regional anesthesia from a niche subspecialty into a mainstream practice accessible to all, offering patients consistent, reliable, and personalized pain relief.

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