Regional Anesthesia at Outpatient Surgery
Regional Anesthesia at the Outpatient Surgery Center
Description of OPSC REG provided by Dom Jose, Class of 2022
6:00 I arrive at OPSC and take a look at the schedule. One of our great regional fellows will have arranged a list the day before with all the blocks for the day, today we have 26 total blocks. It’s great to have the fellows as both a resource and extra set of hands, as there is no way I could place 26 blocks in one day! After drawing up drugs, the fellow and I split up the blocks that need to be done before the first start cases: there are 4 total so we each take 2.
6:50 The first patient is getting an ulnar nerve transposition, and will be getting a brachial plexus block. We perform our time-out, and take a look with the ultrasound. He has good anatomy, which makes the block fairly technically easy.. Soon after, I ask him to try to lift his arm to the ceiling before heading back to surgery. He can’t do it—success! I repeat this process for the other first start block, an adductor canal block.
At both the Main ORs and OPSC there is a nurse dedicated to assisting with nerve blocks, and they are a tremendous help. Their help ranges from moving the patients to the block rooms, to placing EKG leads, to the paperwork of charting vitals and postop notes. Also, at OPSC there are 12 ORs, and 6 attendings. Generally, there are between 2 and 3 regional trained attendings, and we work with all of them to get through all the blocks.
8:00 The next round of cases is ready to get going, so I start consenting, and getting ready. By 9:30, I’ve done 5 blocks already, with good variety (brachial plexus, forearm, adductor canal, femoral, sciatic)
9:30 There is a little lull between cases, and I start to call patients from the previous day to see how their pain is and make sure their block has worn off. Ninety-nine percent of patients are extremely grateful for their regional anesthetic, and most were pain free for a significant amount of time postoperatively. Everyone’s block has appropriately worn off 24 hours postop, and it seems the patients are tolerating their pain with oral meds.
10:30–14:30 This time was a nonstop whirlwind of consenting patients, drawing up more drugs, and performing blocks. By the end of the day I’ve performed 14 blocks, which is fantastic. The fellow did the other 12. The OPSC regional resident can go home whenever all the blocks are done, I stick around for about 15 more minutes to quickly check on my patients in PACU and do a few more phone calls for patients that I blocked the previous day.
We get a fantastic regional volume at UVA. The minimum ACGME requirement is 40 blocks, and by the end of my first OPSC week I have done… exactly 40!