settings, nerve blocks are used in a mere 3% of surgeries that are eli-
gible for them. Even during shoulder arthroscopies — obvious can-
didates for regional anesthesia — blocks are used only 41% of the
time, giving patients a less-than-a-coin-flip chance of getting one.
If only a small number of anesthesia practitioners are using basic
blocks, even fewer understand and perform the newer novel blocks
that have emerged. The advent of these often more complicated
blocks can easily intimidate some practitioners and convince them to
avoid using regional anesthesia at all.
This "complexity bias" has widened the gap between pioneers in the
field and anesthesia generalists, and patient care may suffer in the
long run. While the pursuit of new techniques is always a worthy one,
I also think there needs to be a movement toward getting the most
out of the current blocks we have (see "5 Blocks Every Provider
Should Know").
A back-to-basics approach — offering a basic blocks package and
standardizing how they are taught and implemented — would
bridge the gap between academic experts in the field and practi-
tioners who are in the trenches every day. It would also go a long
way toward providing patients with more consistent and reliable
opioid-sparing pain-relief.
Gradual change
Making competency in even a basic set of blocks the norm won't hap-
pen overnight. Training must evolve. Currently, an anesthesiology resi-
dent must have provided care to 40 peripheral nerve block patients in
order to graduate. There's no breakdown, however, on which nerve
blocks must be performed or how many times they're used. So, a resi-
dent can theoretically meet the requirement by administering 40 dif-
ferent nerve blocks one time each. For experienced anesthesia practi-
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