Regional Anaesthesia Special Interest Area (SIA)

1.      Introduction

This special interest area (SIA) in Regional Anaesthesia (RA) is designed to provide comprehensive knowledge, hands-on skills, and proficiency in regional anaesthesia, while also promoting safe practice, research, and continuing professional development (CPD).

 

2. Programme Overview

  • Ideally 6 months, but at time of writing the School are allowing shorter 3-4 month SIAs placements in RA.
  • Duration may depend upon:
    • Duration of other SIAs (total SIA duration 12 months whole time equivalent to be undertaken in 1-3 areas of special interest. RA is in the Group 2 SIA choices, which are to be undertaken over 3-6 months per SIA).
    • Seniority and existing level of expertise in RA.
    • Pre-agreed objectives for placement.
    • Related SIAs i.e. complex orthopaedic, vascular, trauma and stabilisation etc.
  • Target Trainees: ST 6-7 (and holder of FRCA) in Stage 3 anaesthesia training, or equivalent.

 

3. Learning Objectives

Knowledge:

  • Anatomy:
    • Detailed study of relevant anatomy for common nerve blocks (e.g., brachial plexus, lumbar plexus, femoral, sciatic, etc.).
    • Ultrasound anatomy and landmarks for block placement.
  • Pharmacology:
    • Local anaesthetics: pharmacodynamics, pharmacokinetics, toxicities, and safe dosing.
    • Adjuvants used in regional blocks.
  • Physiology:
    • Mechanisms of nerve conduction and the effect of local anaesthesia.
    • Systemic effects and complications (e.g., LAST – local anaesthetic systemic toxicity).
  • Clinical Application:
    • Indications, contraindications, and complications of RA techniques.
    • Patient selection for RA vs. general anaesthesia.
    • Multimodal analgesia and its role in enhanced recovery after surgery(ERAS).
  • Safety:
    • Infection prevention, sterile techniques, and monitoring.
    • Handling emergency scenarios (e.g., failed blocks, LAST).

 

Skills:

  • Basic Nerve Blocks: Supervision Level 4- should be able to manage independently with no supervisor involvement (although should inform consultant supervisor as appropriate to local protocols).
    • Upper limb blocks (e.g., interscalene, supraclavicular, axillary).
    • Lower limb blocks (e.g., femoral, sciatic, popliteal).
    • Truncal blocks (e.g., ESP, TAP block, PECS block).
    • Ultrasound-Guided Techniques:
    • Peripheral Nerve Block Equipment:
    • Proficiency in the use of ultrasound for guiding needle placement.
    • Ultrasound scanning techniques for identifying nerves, vessels, and landmarks.
    • Needle handling skills and image interpretation.
    • Familiarity with block needles, catheters, and ultrasound equipment.
  • Continuous Nerve Block Techniques:
    • Use of perineural catheters for continuous analgesia.
    • Pump and catheter management.

 

Developing expertise:

  • Independently organise, lead and evaluate the effectiveness and efficiency of an operating list planned under RA alone.
  • Supervise and advise colleagues in suitability and delivery of RA in complex cases.
  • Evaluate the place of RA, and any developments, within the patient perioperative pathway and advise on potential changes in practice.

 

4. Clinical Exposure

Supervised Practice:

  • Except in rare circumstances, most training and solo lists should have the potential for exposure to RA (see point 10 below). “Regional SIA” should  be added to the trainees name on CLW to to help ensure they are allocated appropriate lists.
  • Training sessions with consultants with established RA expertise (see point 10 below).
  • Practice of a range of RA techniques in orthopaedic, trauma, vascular and day-case surgery.

 

Case Mix:

  • Exposure to elective and emergency cases across a variety of specialities (e.g., orthopaedics, general surgery, vascular).
  • Opportunity for performing blocks in non-operating room settings (e.g., labour analgesia, chronic pain).

 

Block Numbers:

  • Recommended to document a minimum number of blocks (e.g., 50-100 blocks) with an appropriate balance of techniques.

 

Service Delivery:

  • Trainees will contribute as a senior anaesthetist to the trainee on call rota. On a long day, trainees should usually be in a training list specific to their RA SIA during the day and join the on call team from 18:00.
  • Once identified as having acquired the appropriate knowledge, skills and expertise, trainees will be expected to independently organise and manage appropriate solo lists requiring RA input.

 

5. Education and Teaching

  • Trainees are encouraged to contribute to the organisation and delivery of education:
    • Comfortably Numb RA Course, Cheltenham, organised by Toby Jacobs (t.jacobs@nhs.net), usually runs in January. Trainees may wish to be a trainee lead on course.
    • Regional Anaesthesia Block Club, which runs between 1-2 weekly (no specific day, sessions organised according to facilitator availability, usually at 8AM at GRH). Trainees may wish to take over the organisation and running of the Block Club or facilitate sessions.
    • Involvement in organising or delivering other RA-related workshops or simulation sessions.
    • Facilitate teaching junior colleagues or medical students.

 

  • Formal Teaching Sessions:
    • Case discussions, morbidity and mortality reviews, and journal clubs.

 

  • Self-Study:
    • Access to e-learning modules, textbooks, RA guidelines, ultrasound for free scanning and Blue Phantom to improve needle technique.
    • Review of recorded ultrasound-guided procedures.
    • Use of the Glos Hospitals Teaching Whatsapp group to offer to seek or share learning opportunities or supervise other trainees.

 

6. Assessment and Feedback

Structured Learning Events (SLEs)

There is no minimum requirement for numbers of SLEs during the SIA module but it is useful to undertake these regularly and to use them as evidence towards your sign off at the end. You should aim to achieve entrustment level 4 by the end of the module.

  • Example DOPS (Direct Observation of Procedural Skills):

Various RA techniques.

  • Example A-CEX (Anaesthetic Clinical Evaluation Exercise):

Awake cases.

Asleep cases.

  • Example CBD (Case Based Discussion):

Decision-making.

Patient management.

  • Example ALMAT (Anaesthetic List Management Tool):

Block list.

  • Example A-QIPAT (Anaesthetic Quality Improvement Project Assessment Tool):

RA-UK conference.

Comfortably Numb.

 

Logbook:

  • Maintenance of a personal logbook of all performed blocks, noting outcomes, complications, and reflections.

 

Feedback:

  • Regular feedback from supervisors on technique, decision-making, and performance.
  • Mid- and end-of-rotation review by ES to assess progress and address any gaps.
  • MTR.
  • Contribution towards MSF.

 

   Sign  off :

  • The SIA will be assessed and signed off by Toby Jacobs (t.jacobs@nhs.net).
  • Please add Toby as a Clinical Supervisor on your LLP so he can access MTR/ HALO etc

 

7. Project Work

  • Research projects, audits, and quality improvement initiatives.
  • Present cases, literature reviews, or RA research findings at departmental or national meetings.

 

8. Continuing Professional Development (CPD)

  • Conferences and Workshops:
    • Attendance at regional or national conferences focused on RA (e.g., ESRA, ASRA, RA-UK, SOWRA).
  • Certification:
    • Optional certification in regional anaesthesia (e.g., through ESRA/ASRA).
  • Networking:
    • Opportunities to collaborate with RA specialists, attend multidisciplinary team (MDT) meetings, and foster professional networks.

 

9. Evaluation of the Special Interest Area

  • Trainee Feedback:
    • Collect feedback on the quality of teaching, clinical exposure, and support during the training.
  • Quality Assurance:
    • Regular review of the programme to ensure it remains up-to-date with clinical and educational developments in RA.

 

This structure ensures a well-rounded training experience that combines theoretical knowledge, clinical application, skill development, and research in regional anaesthesia.

 

10. The Practicalities

Anaesthetic Consultants/ SAS with a specialist interest in Regional Anaesthesia

Toby Jacobs

Sam Andrews

Jim Self

Trevor Johnson (inc spinal USS)

Laura Beard

Tom Perris

Jyothi Nimmagadda

Robin Cooper

Neil Kellie

Tom Renninson (vasc, inc nerve catheters)

Lawrie Kidd (vasc, inc nerve catheters)

Caleb McKinstry

Martina Nejdlova

Tom Knight

Matt Oram

Simon Webster

Ian Godfrey

Rob Orme

Mark Haslam

Jo Collins

Owen Bodeycombe (inc suprascapular for shoulder scopes, interventions in pain clinic and chest wall blocks for cardiology implants)

Sunni Karadia

Jonathan Lightfoot (paeds urology blocks)

Hugo Hunton (breast surgery chest wall blocks)

 

Many other anaesthetists working in CGH ortho/ trauma also do blocks

 

Relevant surgical lists

  • Upper limb/ hand: Mason, Hazelrigg, Tredgett, Aung, Engelke, Batten, Bigsby, Takwale
  • Shoulder: Engeleke, Batten, Peter, Juanjoyee, Aung, Bigsby, Takwale

 

  • Foot/ ankle: Hutt, Clint, Grote, Henderson, Hutt
  • Knee: Gleeson, Kempshall, Farooq, Kalap, Barksfield, Dodds, Holt, Gosal, Mutimer, Atwal, Pegrum
  • Hip:Curwen, Kalap, Gleeson, Barksfield, Dodds, Holton, Holt, Gosal, Mutimer, Atwal, Pegrum

 

 

Working in CGH Orthopedic Theatres

  • CGH orthopedic theatres (Apollo, Globe, Phoenix, St Paul’s theatres) are located in the Orthopedic Unit, College Road/ St Paul’s Wing.
  • Trainees can move between theatres within the orthopedic theatre complex to do a variety of blocks.
  • White clogs are needed to enter theatres, please ask at reception for a pair if you will be on a Regional SIA as many of your lists will be here. Theatre hats must be worn once past the entrance to orthopedic theatres.
  • Ortho: Women’s changing room code C1958. Men’s changing room code C5376.
  • Patients are assessed from 07:30 in the Orthopedic Admission Suite (OAS)/ Painswick Suite.
  • Team brief in theatres at 08:30.
  • After recovery, patients go back to Snowshill/ Bibury wards post-operatively.
  • Many are discharged as day cases, but Snowshill/ Bibury keep inpatients.

 

  • Saturn/ Th 8 is located in Chedworth Surgical Unit, Centre Block.
  • Elective orthopedic lists are also done in this theatre, although it is distant from the main orthopedic theatre suite, and therefore more difficult for trainees to move between theatres doing blocks.
  • GT: Women’s changing room code 5678. Men’s changing room code 1234.
  • Patients are assessed from 07:30 on the Chedworth Surgical Unit.
  • The exception is any joint replacements who are assessed in the Orthopedic Admission Suite (OAS)/ Painswick Suite. These patients will also go back to Snowshill/ Bibury wards post-operatively.
  • Team brief in theatres at 08:30.

 

  • Breast lists in Chedworth Surgical Unit provide opportunities for chest wall blocks (Hunton and others)

 

Working in GRH Theatres

  • GRH MOTS Th 10-14 are the trauma theatres (NB Th 12 usually does spines and rarely useful RA lists here). Variable block opportunities here dependent upon surgeon and anaesthetist.
  • Trainees can move between theatres within the orthopedic theatre complex to do a variety of blocks.
  • Main: Women’s changing room code C1960. Men’s changing room code C1950.
  • The trauma list is released at 08:30, but a golden patient should have been identified before this and should have been emailed to the anaesthetic Consultant the night before, or can be found from the desk at the crossroads between trauma theatres.
  • Trauma patients coming in on the day of surgery usually come into Ward 2a annex.
  • Trauma inpatients are usually on wards 3a
  • The GRH ortho/ trauma flexible float’s role is to help pre-op assess patients or provide breaks to allow trauma theatres to run smoothly. There may be options in this role to move between theatres doing blocks in trauma.
  • Vascular lists (esp Jacobs/ Renninson/ Kidd/ Cooper) can provide good opportunities for blocks, including nerve catheters.
  • Paeds urology (Lightfoot) provides opportunities for ilio-inguinal and ilio-hypogastric blocks
  • Emergency Theatres (1 and 2) may provide opportunities for ESP catheters, thoracic epidurals, abdominal wall blocks etc.
  • Pain clinic and cardiology implants (chest wall blocks) (Bodeycombe) may provide other RA opportunities, but it it worth looking at the lists and contacting the Consultant in advance.

 

 

SIA unit lead:
Dr Jacobs 

This page was last updated June 25th 2025 (11 hours ago)