 |
| Figure
1 - Demonstration of a continuous
cervical paravertebral block on a volunteer |
Basic RASCI workshops are presented
on Saturdays. After registration at 7:30, delegates move
to the operating room where the morning is spent teaching
cadaver-based anesthetic anatomy of the upper and lower
limbs, surface anatomy demonstrated on volunteers and
finally demonstration of all the basic nerve block techniques
on the volunteers. The emphasis of this workshop is on
techniques that will provide practitioners with a working
knowledge of all single injection blocks required for
modern orthopedic anesthesia practice. Some continuous
nerve block techniques, e.g. continuous femoral nerve
block, will be demonstrated.
After lunch, the delegates move
to the animal laboratory where all these blocks are performed
by the delegates on live anesthetized pigs. The group
is split into small groups of 4-5 delegates per animal
and each group has its own faculty attending. The last
best single injection or continuous catheter will be
dissected post-mortem after injection of india ink. |
In
order not to disturb working schedules, RASCI workshops
are presented over weekends.
After registration at 7.30 AM, the program starts on
Saturday
with an introductory lecture. Thereafter the delegates move
to the operating room where the morning is
spent
on in-depth teaching of the anesthetic anatomy of the brachial
plexus and peripheral nerves of the upper extremity. This
teaching is first accomplished using specifically dissected
and plastinated
cadaver. Surface anatomy is then demonstrated on a volunteer
and the faculty then demonstrates the actual blocks and
catheter
techniques on the same volunteer. These techniques are
similar to clinical practice (Figure 1).
The afternoon is similarly
spent teaching the anesthetic anatomy of the lumbo-sacral
plexus and the peripheral nerves of the lower extremity
on
the cadaver. This is again followed by a demonstration of
the surface anatomy and the actual blocks on the human
volunteer
(Figure 2). These volunteers are locally recruited and receive
compensation from RASCI.
The second day, delegates
have the opportunity to do the blocks and catheter techniques
on fully anesthetized pigs. Animals are housed, cared for
and
anesthetized according to the strict guidelines set by Institutional,
National and International animal care and ethical standards.
The class is then divided into
4 to 6 groups of 4 delegates per group and each
group has
its own animal. There is a dedicated faculty member at each
table to teach and help the delegates to
perfect
their techniques. Before a specific technique is done, a
faculty member demonstrates that block in detail (Figure
3). The delegates
then divide into their small groups and, under the direction
of the faculty member assigned to that group, practice
that
block until all members of the group succeeds.
The whole morning is spent on systematically
dealing with each nerve block and catheter technique.
These
include femoral nerve block, axillary block, infraclavicular
block, interscalene block, sciatic nerve block, all the
paravertebral
blocks and all the epidural block techniques as appropriate
to the level of experience of the group members. People
with
similar experience and expertise are grouped together
as much as possible. After the lunch break, delegates
get to
spend a few hours practicing the blocks and catheter techniques,
with which they feel they need more experience, and
which
are most appropriate to their specific clinical practices.
This time is also spent on demonstrating specific techniques
unique to the practice situation of a specific delegate on
a one-on-one basis. Examples of these include retrobulbar
eye blocks, intrapleural blocks, etc. Each delegate is then
asked to place his or her best block or catheter and,
after
formal euthanasia and exsanguination of the animals, while
still under full general anesthesia. India ink is injected
through the catheters and the delegate gets the opportunity
to dissect the catheters out to see where the catheters
were
in relation to the nerves. To see how the nerves respond
to nerve stimulation
and then to actually see where the catheters are in relation
to the nerves, serves as a very valuable learning experience. |
