Regional Anesthesia Rotation
The Purpose (why) of the Regional Anesthesia Division is to provide intra-operative and postoperative analgesia for the Orthopedic, Renal, and Plastic Services.
The Objectives (how) are to:
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teach anatomy of the extremities
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learn nerve block techniques for the brachial, lumbar, and sacral plexuses
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manage the analgesia through the Acute Pain Service post-operatively
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utilize the various methods for performing blocks: perivascular (inter-fascial), nerve stimulator, IV regional, and ultrasound
The Goals (what) are that the resident:
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be able to mark the relevant landmarks for the blocks
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use the nerve stimulator when appropriate
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become adept using the ultrasound
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perform single-shot techniques
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be able to insert catheters for continuous techniques
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be able to draw frontal, sagittal, and transverse sections of the blocks they have performed
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manage the regional service
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learn appropriate sedation regimens
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follow aseptic techniques
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be exposed to the techniques of several attendings
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perform four approaches to the brachial plexus: axillary, infraclavicular, supraclavicular, and interscalene
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perform approaches to the lumbosacral plexus: femoral, obturator, saphenous, sciatic, and popliteal.
We have developed strong relationships with:
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Dr. Uhl, Chief of Orthopedics and hand specialist, for upper extremities continuous blocks.
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Dr. Dipreta, orthopedic foot and ankle specialist, for lower extremity continuous blocks
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Dr. Gallichio, renal surgeon, for upper extremity single-shot blocks for arterio-venous fistulas
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Dr. Czajka, orthopedic knee and hip specialist, for continuous femoral nerve blocks
"A day in the life of a Resident in Regional"
This is what Dr. Presley says about the Regional Rotation:
"Our regional anesthesia department has matured to include a 'regional operating room', ultrasound, nurse practitioner, and five full time faculty dedicated to enriching the resident’s exposure to a large variety of regional nerve blocks. Our residents do extensive work with indwelling nerve block catheters and techniques on par with those utilized by most fellowship programs.
In the afternoon, the resident can expect to perform more procedures or receive formal instruction from the respective faculty member. The faculty here are very competent, skilled and most importantly: excellent at teaching.
A typical day includes setting up the regional O.R. at 6am and having the first patient in the room by 630am. The resident, on average will place 4-6 nerve blocks before 12 noon; sometimes performing more than one block per patient. After lunch, the resident will round on those patients which have indwelling nerve blocks throughout the hospital in addition to performing consultations from other services. "
Dr. Larry Presley
Our designated Regional Attendings
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"I began my regional anesthesia training in 1973 under Dr. Popper, an older Austrian anesthesiologist. He taught me continuous spinal anesthesia with a malleable needle and supraclavicular blocks with elicited paresthesia to localize. From this experience I learned that the needle must always be kept straight during insertion. Now I use Winnie’s interfascial technique to place the local anesthetic inside fascial planes. I use fascial ‘pops’, motor nerve stimulation, and ultrasound to verify proper placement, and I always insert a catheter for post-operative pain control. " |
 Dr. Arup De |
"My interest in regional anesthesia began during my residency in Boston, and became an integral part of my anesthetic technique during my experience in private practice. I enjoy performing ultrasound-guided blocks, for both upper- and lower-extremity procedures." |
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"I'm Board Certified in Anesthesiology and Pain Medicine. I Graduated from Medical School in Budapest, Hungary. I trained in Anesthesiology and Pain Medicine at Columbia University, New York. My special interest in medicine is regional anesthesia, and implantable devices to treat chronic pain." |
