Fellowship in Regional Anaesthesia - Plymouth NHS Trust
Overview
This is a 6 month - 1 year (negotiable) Fellowship in Regional Anaesthesia at Derriford Hospital, Plymouth.
Our well established departments of orthopaedics and trauma, plastics and vascular surgery ensure that there are plenty of opportunities to observe and perform peripheral and central regional blocks. As a major trauma centre we have many complex patients where advanced regional anaesthesia techniques can make an important contribution to their recovery.
Training and clinical opportunities will be provided in
- Ultrasound guided Peripheral Nerve Block techniques (main focus)
- Peripheral nerve stimulation techniques
- Continuous catheter techniques
- Acute pain applications of RA (e.g chest trauma)
- Service Developments including logistics of running regional lists
Clinical opportunities
There is widespread use of regional anaesthesia throughout the department, predominantly in the busy orthopaedic/trauma and plastic surgical units.
There are currently 3 elective orthopaedic theatres and a dedicated trauma theatre. A new orthopaedic unit is planned for 2023 which will add 3 further theatres. All the usual range of elective orthopaedic sub-specialties are represented - lower limb arthroplasty, pelvis, shoulder and upper limb, hand, and foot & ankle. In addition Plastic surgery, with 2 dedicated theatres and a plastics trauma session each afternoon, and vascular surgery theatres offer further opportunities for regional techniques. Regional anaesthesia is well accepted and often encouraged by the surgeons. In addition to single shot nerve blocks, catheter techniques are commonly performed for abdominal surgery, amputations, and chest trauma. The upper limb service has regular hand and wrist lists where awake surgery is widely used and supported.
Nearly all our peripheral regional anaesthetic blocks are now performed using ultrasound guidance -there is good provision of machines within the department. Facilities exist to record ultrasound footage for teaching and assessment purposes. We do not operate a block room model and most regional blocks are placed in the anaesthetic rooms prior to surgery.
Several members of the department have a major sub-specialist interest in regional anaesthesia and are active members of local and national regional anaesthetic organisations (RA-UK & SOWRA), and regularly teach on courses at a regional and national level.
The following peripheral blocks are routinely performed within the dept.
Upper Limb: Interscalene (+/- catheters) / Supraclavicular / Infraclavicular (+/-
catheters)/ Axillary / Distal forearm blocks /Superficial cervical plexus
Trunk/Neuraxial: TAP and rectus sheath (+/- catheters) / Paravertebral block / PECS /
Serratus plane (+/- catheters) / Erector Spinae Plane block (+/- catheters)
Lower Limb: PENG Block / Lateral cutaneous / Femoral / Adductor canal / Sciatic –
proximal and popliteal / IPACK / Ankle
During the fellowship we will endeavour, where possible to place the fellow in lists where RA can be utilised. There will be a mix of accompanied lists where new skills can be acquired and solo lists, where skills can be consolidated. Naturally the majority of lists will be in the specialties of Orthopaedics, Trauma or Plastics, but there is the opportunity to spend time in other areas to gain specific skills e.g breast lists, vascular etc.
The RA fellow will participate in the senior-tier on call rota.
Non Clinical
Audit/Quality Improvement: Plenty of opportunities exist to audit practice and the applicant will be expected to participate in at least one major audit or QI project.
Research: Support is available for fellows wishing to initiate a project - applicants are encouraged to discuss potential research projects prior to taking up the post in order to maximise the time available to undertake the clinical aspects of the project. Funding for projects is available both nationally and locally (South West Regional Anaesthesia group - www.sowra.org.uk). The applicant will be encouraged to present their work nationally and internationally.
Teaching: The Regional Fellow will be expected to supervise junior colleagues on accompanied lists, and to provide ad-hoc regional anaesthetic support and training to other colleagues (both trainee and Consultant) as necessary. In addition they may have the opportunity to participate as workshop faculty on the annual SOWRA regional anaesthesia course. Previous fellows have contributed chapters to resources such as the e-LA platform and book chapters.
Management and Administration Experience: Fellows are encouraged to develop service improvement ideas related to the regional anaesthesia service.
Other Training Opportunities
Fellows are encouraged to consider formal higher education in the field of regional anaesthesia. Currently there are 2 popular options:
1) The European Diploma (EDRA)- full details are available on the ESRA website.
The EDRA is a popular choice with UK trainees. Within the department we have several EDRA diplomates and an EDRA examiner and so have a good understanding of the requirements of the exam. This is a very achievable additional qualification to help
2) MSc in Regional Anaesthesia- this distance learning course run by the University of East Anglia aims offers a Masters level qualification in regional anaesthesia.
Key Contacts
Clinical Supervisor: Dr M Oldman
College Tutors: Dr A Biffen & Dr T Bradley
Anaesthetic Service Line Director: Dr S Bree
Service Line Cluster Manager: Mrs W Colley
Informal enquiries are always welcome – please contact Dr Matt Oldman, Consultant Anaesthetist.