Background and Goal of Study: Advantages of regional anaesthesia (RA) for sole anaesthesia or
supplemental analgesia are well known [1]. Achieving proficiency in its delivery requires time and
training opportunities. It is estimated that a caseload of around 50 is required before procedural
competence is achieved [2]. Whilst this can be attained via RA training modules, the need to match
trainees with adequate exposure to RA techniques is essential for skill acquisition.
Materials and Methods: Data on elective orthopaedic operations have been prospectively
collected at our teaching hospital, recording the cases with planned RA and the type of blocks. The
presence of trainees, and whether they were working solo or doubled up with a Consultant or the
senior organizing anaesthetist (SOA) was also identified.
Results and Discussion: We present the results of the first 6 months of this ongoing prospective
audit. 2761 operations were scheduled across 823 theatre lists. This involved 1544 nerve blocks for
1313 patients: 643 (41.6%) neuraxial, 713 (46.1%) lower limb, 194 (12.6%) upper limb and 3 (0.2%)
other blocks. Despite 1.9 nerve blocks performed per list, trainees were present at 160 (19.4%) and
doubled up with a non-SOA Consultant at only 69 (8.4%) of the total lists. A clear discrepancy exists
between training opportunities availability and trainee allocation. A greater number of trainees need
to be allocated to elective lists and paired with a non-SOA Consultant more frequently. There
remains an onus on trainees to rotate between theatres to increase exposure.
Conclusions: This prospective audit has quantitatively confirmed our anecdotal impression that
training opportunities are not fully utilised. We will highlight this shortfall to our department and reevaluate
training experience over the next six months.
References:
1. Mingus M. Recovery advantages of regional anaesthesia compared with general anaesthesia.
JCA 1995; 7(7):628-633.
2. Kopacz D. The regional anaesthesia “learning curve”. What is the minimum number of epidural
and spinal blocks to reach consistency? Regional Anaesthesia 1996; 21(3):182-90.
Acknowledgements: We acknowledge the help of Emma Walduck and all theatre staff for data
collection.

Challenges of regional anaesthesia training: a prospective audit in a teaching orthopaedic hospital