[Nitecap]

Regional and neuraxial anesthesia are important skills an anesthetist possesses. However as many have told me CRNA's and AA's ability to do regional anesthesia at their practice settings have been limited by Anesthesiologists who many times are employing that anesthetist. Wanted to see how frequently anesthetists (CRNA or AA) are doing regional and neuraxial techniques. When I see doing I mean actually placing the block not just bolusing epidurals ect. Also due to the fact that many CRNA programs are sending SRNA's to remote clinical sites that are many times private practice I have heard frequent reports of them getting very little Neuraxial and regional training in school? So SRNA's please respond too.

What types and how often?

Who is limiting practice?(Hospital, anesthesiologist, personal pref, program)

What is the excuse for limiting practice since you are licensed to administer regional anesthesia?

How important do you feel regional anesthetic experience is to a you as a provider as far as marketing your skills and experience?

How much regional experience did you get or are you getting in CRNA school?

[Nitecap]

Seems like peeps are responsing to the poll but not the thread it self so ill make a comment. Not really into clinical yet but orienting the OR and have witnessed the students doing a good bit of regional. Tons of epidurals and spinals as at the county hospital and our main clinical site there are about 650 babies delivered a month.

As well being a level one trauma center and academic hospital they arent so worried about turning over the room so quickly b/c the regular say lap appy or lap chole that takes a private practice guy 30 min may take a resident 3hrs. With this being the case the attending really like you to get as much regional experience as possible. If its your case you do the block. If you havent planned for a regional and the attending want to place a block just for postop pain mgmt a anesthesia resident that pretty much places blocks all day will place the block. Freq blocks include brachial plexus all diff. approaches, ankle blck, bier block, siatic and femoral blck, 3 in 1 block, tons of epidurals and spinals. So really just due the the fact that our main clinical experience is at an extremely busy county hospital and trauma center.

It is in my opinion that having great regional experience make you a more marketable anesthetist. It opens up more independent contractor possibilities as well as other job opportunities. Many new SRNA's even the ones that do a lot of region in school and go work for a MD group that resricts their practice for years will forget for the most part how to do the regional or at least not be as comfotable or proficient as those that do them frequently. Not sure though its just my opinion especially if your thinking about future rural practice opportunities.

[EmeraldNYL]

The students in my program seem to get tons of spinal and epidural experience, but experience with other blocks is kinda hard to come by. They don't seem to do them all that often, and when they are indicated, the docs will do them in the preop area to save time while you are in the room finishing up your previous case.

[MaleAPRN]

Same here in my program. We get enough spinal and epidural experiences, but seldom do we have the opportunity to do other regional blocks. The docs pretty much have a "monopoly" on them.

[rn29306]

Originally Posted by vinnysca

Same here in my program. We get enough spinal and epidural experiences, but seldom do we have the opportunity to do other regional blocks. The docs pretty much have a "monopoly" on them.

Ditto here. CRNAs run OB almost independently and certainly with no MD in the room from anesthesia. That is where the majority of our regional comes from. If a patient gets a block downstairs in the main OR, the docs almost always do it.

Rare occasion, but the other day I got to do a lateral paramedian approach spinal actually in the OR. Guess the MD was feeling generous, but I ain't complaining. Have never attempted a lateral approach, much less a paramedian at all. Acted cool, sank it on first attempt. Booya.

[heartICU]

We have a separate month for a block rotation where we get to do all the upper and lower extremity blocks. We have two months of ortho and two months of OB so spinals and epidurals are not a problem. Also do a lot of thoracic epidurals during cardiac. The block rotation is where we typically get the peripheral nerve blocks. Never have a problem getting the experience.

We do some cervical blocks during vascular - and a few students have done intercostal and/or paravertebral blocks.

[rn29306]

Originally Posted by heartICU

We have a separate month for a block rotation where we get to do all the upper and lower extremity blocks. We have two months of ortho and two months of OB so spinals and epidurals are not a problem. Also do a lot of thoracic epidurals during cardiac. The block rotation is where we typically get the peripheral nerve blocks. Never have a problem getting the experience.

We do some cervical blocks during vascular - and a few students have done intercostal and/or paravertebral blocks.

That's impressive right there. I don't care who ya are, that's impressive right thar.

[CougRN]

we do rotations for regional for mostly spinals. we do bier blocks every now and then but epidurals and any other regional, including epidurals, are hard to come by. will probably graduate without ever doing anything besides bier block, spinals, and maybe 5-10 epidurals. sucks but that is the climate in the NE.

[Pete495]

Same situation here Coug. mostly spinals, epidurals, and beir blocks. we are getting shipped out for spinals and epidurals as well.

[Bamadawg]

We get plenty of RA experience here at Bridgeport. Mostly spinal and epidural but no shortage of bier blocks, femoral nerve blocks. The interscalenes can be a little hit or miss because here you are thrown into an OR early with only an attending. So he is out in holding doing the block while you are in the room. You still get them but more like 8-10 ISB versus the 30 I could have potentially got. Otherwise plenty of other blocks. WHen you are on call here, all it takes is a call to the CRNA on OB to page you for epis. This is the northeast but not like the rest of the northeast.

Frank