Plan A blocks in regional anaesthesia: a narrative review

Comprehensive Summary

Plan A blocks have become a core in regional anesthesia in locations such as interscalene brachial plexus, axillary brachial plexus, femoral nerve, adductor canal, sciatic nerve, erector spinae plane, and rectus sheath. The goal of this article is to look at the importance of these blocks, along with looking at the current educational methods in aims to identify the best practices for hospitals to adopt for novice anesthesiologists. Plan A blocks act as a stepping stone into more complicated nerve blocks, offering novice anesthesiologists a chance to learn with “high-value and versatile nerve blocks with the goal of creating a core foundation of regional anesthesia skills.” A Delphi study was initiated to determine the core regional anesthesia curriculum, and of this, interscalene and axillary brachial plexus blocks, femoral nerve blocks, and sciatic nerve blocks in the popliteal fossa were the four noted to be of major importance, reaching the cutoff of 70% in a panel of 469. Additionally, a pediatric Delphi project was performed and a similar result emerged, supporting the original Delphi project of incorporating regional Plan A nerve blocks into the curriculum for anesthesiologists. Each of these nerve blocks provides specific value when considering patient outcome, potential harm, and effectiveness of the block. With this information from the study, this article calls for a change to the current UK guidelines in trainees anesthesiologists training, pushing for more Plan A nerve block centered approaches in the later years of residency, as 38% of UK anesthesiologist trainees said they felt comfortable performing a regional nerve block. This incorporation includes breaking the current barriers that exist, including a lack of confidence in training. To counteract this, learning opportunities such as workshops and teaching materials, practice ultrasound devices, have begun to become available to provide more opportunities to learn. Finally, the article addresses the current controversies exist with the incorporation of Plan A blocks into the learning curriculum. These include lack of agreement between professionals, “choice overload”, and the inconsistencies in the type of block to perform in specific situations.

Outcomes and Implications

The importance of regional nerve blocks will only become increasingly significant, with more targeted precision therapy with fewer complications and an increase in patient satisfaction in the near future. The article aims to call for an alteration to the current curriculum in the UK for in training anesthesiologists, increasing the exposure to regional anesthesia. The goal of this is to provide the trainees with the necessary experience and exposure to feel comfortable by the later years of their training. This will likely involve simulation-based training to mimic real life scenarios, giving the trainees stress free opportunities to practice with Plan A nerve blocks. This is set to be the foundation to allow the trainees to progress into more complicated nerve blocks. As more anesthesiologists become increasingly comfortable with complicated nerve blocks, this will ultimately lead to a rise in patient satisfaction, decrease overall dependence on opioids during surgery, and better post-op pain scores. Additionally, as it becomes increasingly common, the lack of agreement between professionals should gradually decrease, giving rise to standards based on the best practices available.