A back-to-basics approach — offering a basic blocks package and standardizing how they are taught and implemented — would bridge the gap between academic experts in the field and practitioners who are in the trenches every day. It would also go a long way toward providing patients with more consistent and reliable opioid-sparing pain-relief.

Gradual change

Making competency in even a basic set of blocks the norm won't happen overnight. Training must evolve. Currently, an anesthesiology resident must have provided care to 40 peripheral nerve block patients in order to graduate. There's no breakdown, however, on which nerve blocks must be performed or how many times they're used. So, a resident can theoretically meet the requirement by administering 40 different nerve blocks one time each. For experienced anesthesia practitioners, access to improved simulation tools are needed in order for them to maintain their current skills and learn new ones. In day-to-day clinical practice, narrowing the range of block procedures that general anesthesia practitioners perform regularly will help them hone their techniques and competency.

I also suggest training to the highest level of care. If regional anesthesia is going to be offered at all, every anesthesia practitioner should be able to perform effective continuous nerve blocks (CNBs) with catheter insertion because the worst block is the one that wears off in the middle of the night, leaving the patient in pain. The second worst block is the one that lasts too long from the patient's perspective. When they don't have control over the operative limb, they describe the feeling in the arm or leg as "paralyzed" or "dead."

Long-acting suspended release blocks or a cocktail of adjuvants don't provide titratability, which gives patients the feeling of control that they want. CNBs are currently the only titratable, long-duration nerve blocks. In terms of personalized pain medicine for surgical patients, there's nothing else like it. From the patient's perspective, it's never good to have a therapy that you can't adjust and can't control.

Increased access

The most important discussion for administrators and managers in outpatient surgery settings surrounds increasing access to regional anesthesia for every patient who would benefit from it. One way to deliver consistent care is to standardize the procedures offered. Having ultrasound guidance available and the latest technologies in anesthetic delivery systems should make it easier to establish consistent techniques for regional anesthesia and help your practitioners learn and perform effective continuous nerve blocks. You should work with your anesthesia team to standardize a blocks package and work with them to ensure they're administered the same way to each patient.

For regional anesthesia to no longer be considered a novelty, it has to be cemented as a core competency for all anesthesia practitioners. We have decades of research proving regional's effectiveness, so there's no reason every practitioner can't be as well-trained in placing nerve blocks as they are in airway management.

We need to start pushing for the widespread use of regional anesthesia, so more patients have access to it. Creating a deliberate strategy of standardizing a small number of versatile, high-value nerve blocks is what will transform regional anesthesia from a niche subspecialty delivered by and for a few into a mainstream practice performed and received by many. OSM

Making competency in even a basic set of blocks the norm won't happen overnight. Training must evolve. Currently, an anesthesiology resident must have provided care to 40 peripheral nerve block patients in order to graduate. There's no breakdown, however, on which nerve blocks must be performed or how many times they're used. So, a resident can theoretically meet the requirement by administering 40 different nerve blocks one time each. For experienced anesthesia practitioners, access to improved simulation tools are needed in order for them to maintain their current skills and learn new ones. In day-to-day clinical practice, narrowing the range of block procedures that general anesthesia practitioners perform regularly will help them hone their techniques and competency.

I also suggest training to the highest level of care. If regional anesthesia is going to be offered at all, every anesthesia practitioner should be able to perform effective continuous nerve blocks (CNBs) with catheter insertion because the worst block is the one that wears off in the middle of the night, leaving the patient in pain. The second worst block is the one that lasts too long from the patient's perspective. When they don't have control over the operative limb, they describe the feeling in the arm or leg as "paralyzed" or "dead."

Long-acting suspended release blocks or a cocktail of adjuvants don't provide titratability, which gives patients the feeling of control that they want. CNBs are currently the only titratable, long-duration nerve blocks. In terms of personalized pain medicine for surgical patients, there's nothing else like it. From the patient's perspective, it's never good to have a therapy that you can't adjust and can't control.