CCT in Anaesthetics - Intermediate Level Training

Published: 05/09/2019

Regional

If training in some of the regional blocks identified is not available it should be deferred to Higher Training years [ST 5/6/7] years. While all the blocks listed below may not be available trainees should achieve a broad spread of block experience.

Learning outcomes:

Build on the basic knowledge and skills gained in basic regional anaesthesia
Increase the range of block techniques practiced
Become skilled in performing some more complex blocks under direct supervision
Become skilled in performing some simple nerve blocks with distant supervision

Core clinical learning outcomes:

Perform one each of the following blocks satisfactorily under local supervision
Thoracic epidural and/or combined spinal/epidural
An upper/lower limb plexus block with peripheral nerve stimulation or ultrasound guidance

NB: All competencies annotated with the letter ‘E’ can be examined in any of the components of the Final examination identified in the FRCA examination blueprint section.

Knowledge

Competence	Description	Assessment Methods	GMP
RA_IK_01	Demonstrates understanding of basic sciences as applied to all regional anaesthetic blocks [Cross reference applied basic sciences]	A,C,D,E	1
RA_IK_02	Recalls/discusses advantages and disadvantages, techniques and complications [including management] of a wide variety of blocks including, but not exclusively, major peripheral blocks of the limbs, some cranial nerve blocks and blocks used to treat chronic pain conditions [Cross ref pain medicine]	A,C,D,E	1
RA_IK_03	Demonstrates understanding in the choice of local anaesthetic agents, opioids, use of additives and techniques of administration	A,C,D,E	1,2
RA_IK_04	Outlines the principles of continuous catheter techniques for peripheral nerve blockade and for postoperative analgesia	A,C,D,E	1,2,3,4
RA_IK_05	Demonstrates an in-depth understanding of the principles of ultra sound guided nerve blocks including: The principles of scanning including machine ergonomics, probe selection/handling and the use of acoustic couplant [ultrasound gel] to improve skin contact The importance of the angle of insonation on visibility of structures [anisotropy] specifically related to nerves and tendons The normal sonoanatomy of peripheral nerves and surrounding structures The basic concepts of needling techniques relating to ultrasound guidance (in plane / out of plane) Understanding and recognition of spread of local anaesthetic under ultrasound guidance, distinction between normal intraneural and intravascular injection	A,C,D,E	1

Skills

Competence	Description	Assessment Methods	GMP
RA_IS_01	Demonstrates safe perioperative management of patients receiving regional techniques [identified below] including liaison with theatre staff, surgeons, recovery staff, acute pain teams and ward staff	A,C,D	1,2,3,4
RA_IS_02	Is able to perform central nerve blocks including Caudal and thoracic epidural and CSE	A,C,D	1,2
RA_IS_03	Is able to perform major nerve blocks including: Upper limb blocks [minimum of one such block] Lower limb blocks [minimum of one such block]	A,C,D	1,2
RA_IS_04	Is able to perform minor nerve and other blocks including as many of these as possible: Superficial cervical plexus block Trunk [penile, rectus sheath, intercostal and inguinal blocks] Upper limb [elbow and distal] Lower limb [ankle and distal] Ophthalmic blocks [Cross reference ophthalmic anaesthesia] IVRA Infiltration and fascial plane blocks	A,C,D	1,2
RA_IS_05	Demonstrates ability to recognise and manage adverse effects and complications of the more complex regional anaesthesia described at this level	A,C,D	1,2,3,4