Ultrasound
Guided
Regional
Anaesthesia
Can you
DIY?
James Lai
Auckland City Hospital
Disclosure of equipment support
• Can one safely train oneself in
USGRA ? YES
• Why do we need a prescribed
course of training and minimum
set of standards for USGRA ?
For the benefit of patients and the speciality of
regional anaesthesia
• Training registrars - regional anaesthesia is
a “clinical fundamental” in the curriculum
redesign
• Certification
• Accreditation
Key Concepts
• Time
• Place
• Person
The more time the better....
Key knowledge and skills
• Ultrasound physics and knobology
Select Probe
Select Preset
Select DEPTH and RESOLUTION
Select 2D
Adjust GAIN
Key Skills
• Ultrasound physics and knobology
• Sonoanatomy - image optimisation
and interpretation
Anisotropy
Key Skills
• Ultrasound physics and knobology
• Sonoanatomy - image optimisation
and interpretation
• Needle imaging
Needle Imaging
•
Long axis (in-plane)
•
•
•
Needle aligned with US beam
Excellent needle definition (shaft & tip)
Safe when used correctly
•Short axis
•
•
•
(out of plane)
Needle crosses US beam
Limited needle definition
Needle tip may be “beyond” US beam
QuickTime™ and a
VC Coding
QuickTime™ and a
VC Coding
QuickTime™ and a
VC Coding
Safety
First!
Start with a simple blocks
In-plane needle imaging
Don’t advance unless you see the tip
Use hydrodissection and maintain
good needle visualisation
Inject outside the nerve and observe
spread
• Do we need a prescribed
course of training and minimum
set of standards for all US users
?
• Or can one safely train oneself
in USGRA ? (DIY)
Next Meeting
BATS on ice Queenstown
25th August 2011