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PAEDIATRIC REGIONAL ANAESTHESIA SCANNING CLUB AT THE ROYAL LONDON HOSPITAL
R. Carrington, V. Jenkins, M. Roberts
The Royal London Hospital, London, UK
Introduction and Aims
Regional anaesthesia is an exciting and rapidly developing branch of our specialty. It conveys numerous benefits in the paediatric population including improved early postoperative pain scores and a reduction in opioid analgesia(1). This, combined with evidence of a low incidence of complications make regional anaesthesia a fundamental part of modern paediatric anaesthetic practice(2).
Inspired by the release of the Paediatric Plan A Blocks from RA-UK(3), and enthusiasm from the paediatric anaesthesia department at The Royal London Hospital, we decided to initiate a Paediatric Scanning Club for both consultants and trainees to attend.
We aimed to provide:
- A concise weekly educational session to cover block indications and relevant anatomy.
- An opportunity to increase hands-on ultrasound scanning experience and identification of the appropriate sonoanatomy.
- Discussion opportunity around the differences between the paediatric and adult block, including dosing of local anaesthetic.
Methods
In 2023, we designed and implemented a 7-week programme covering common blocks used in paediatrics including amongst others: femoral, popliteal, axillary and rectus sheath blocks.
Each session was lead by a Stage 2+ trainee on their paediatric anaesthesia placement and supervised by a paediatric consultant anaesthetist proficient in the block of the week.
The trainee leading the session prepared a short presentation including the indications, anatomy, patient positioning, sonoanatomy, recommended local anaesthetic dose and a short video of the block being performed. Following this, there was an opportunity to practise identifying the sonoanatomy on volunteers, and practise needling using jelly containing hidden targets.
We distributed a survey to collect feedback after the 7-week programme.
Results
We received responses from both trainees (67%) and consultants (33%) with 75% of total trainees on the rotation completing the survey (6/8).
- 100% of respondents thought that the Scanning Club sessions they attended improved their theoretical knowledge of performing the relevant block in paediatric patients.
- For every block covered, following the attendance of the scanning club session, more attendees felt confident to perform that paediatric block independently (with a supervisor in the room).
- Suggestions for improvement included: Initiating a changeover time half-way through the session for consultants and trainees who were paired up in theatres to swap over allowing both to attend, and exploring the possibility of scanning practice on paediatric volunteers.
Discussion
This simple format trainee-led teaching session has been positively received by both consultants and trainees and could be easily replicated in other hospitals. The programme has now been repeated three times at RLH, following the three-monthly trainee rotation, with the organisers acting on feedback to make improvements each time. Specific aspects that people have consistently enjoyed include the “small group, focused teaching and regular practice” and that it is a “great opportunity to revise common blocks used in paediatric anaesthesia”.
References:
- P.-A. Lönnqvist, N. S. Morton, Postoperative analgesia in infants and children, BJA: British Journal of Anaesthesia, Volume 95, Issue 1, July 2005, Pages 59–68
- Polaner DM, Taenzer AH, Walker BJ, Bosenberg A, Krane EJ, Suresh S, Wolf C, Martin LD. Pediatric Regional Anesthesia Network (PRAN): a multi-institutional study of the use and incidence of complications of pediatric regional anesthesia. Anesthesia & Analgesia. Dec 2012 Dec;115(6):1353-64.
- RA-UK 2023, Paeds Plan A Posters, https://ra-uk.org/index.php/plan-a-blocks-home/plan-a-paeds/pads-plan-a-posters.html