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When? Monday-Tuesday, September 11-12, 2017
Where? 36th annual ESRA congress, Lugano, Switzerland
What? 35-40 minutes of oral examination in 4 sections: anatomy and landmark demonstration on a live model; ultrasound demonstration of commonly performed blocks on a live model; discussion of a clinical case; problem-solving of a regional anaesthesia-related complication.
The candidate must pass all 4 sections in order to pass EDRA Part II.
Each candidate will be evaluated on his or her knowledge of all techniques.
Anatomy, physiology, and pathophysiology related to regional anaesthesia (including common concomitant diseases such as diabetes, chronic lung disease, bleeding disorders, etc.).
Pharmacology of drugs commonly used in regional anaesthesia and acute pain management.
Methods and strategies in regional anaesthesia and pain therapy for:
gynaecology / obstetrics, children, elderly, trauma, acute and perioperative pain.
Procedure–oriented regional anaesthesia and postoperative pain management.
Application of regional anaesthesia for surgically oriented procedures.
Performance of neural blockades, including neuraxial and peripheral nerve blocks and catheter techniques using landmark, neurostimulation, and ultrasound techniques.
Advantages / disadvantages, risk / benefits and indications / contraindications for regional techniques.
Management of complications and side effects of neuraxial and peripheral nerve blocks, including management of a failed block.
Sedation in regional anaesthesia.
Surgical site analgesia technique.
Equipment, e.g., nerve stimulator, ultrasound, needles, and perineural catheters.
Attitudes and behaviour of the examinee performing regional anaesthesia.
Exam duration: 35-40 minutes
Type of exam: Viva (oral) with randomly assigned standardised questions
Number of examiners: 2 (with the possibility to have additional experts present as examiner candidates: EDRA Vice-Chair responsible for EDRA part II, EDRA Chair or inspectors of International Educational Committees)
Additional equipment: Live model, ultrasound machine
Types of graduation: Pass or fail (see below for details)
Exam structure: 4-section examination (without changing examiner or room)
Part 1: Anatomy, landmark techniques on a live model. (no actual needling of the model)
The candidate must demonstrate on a live model the surface anatomy of an assigned technique and answer questions related to anatomical structures and block performance. The candidate must show different approaches for single-shot and continuous regional anaesthesia techniques. The candidate must be able to discuss indications and contraindications for, and the advantages, disadvantages, complications and side effects of the explained techniques for both ultrasound and neurostimulation. Candidates should know the required muscle response for a successful block and how to interpret other muscle responses. They must also demonstrate knowledge of how to change the needle position according to the muscle stimulation present and the one desired. Block dynamics, choice and volume of local anaesthetics, and needle choice will also be discussed.
Peripheral and central nerve blocks will be examined.
Please note: It is not required to mention patient consent, laboratory, and patient history check prior to block nor hygiene precautions if not explicitly asked. Do not waste demonstration time!
Part 2: Ultrasound techniques
The candidate must demonstrate on a live model a nerve block using ultrasound. Probe handling / orientation, scanning ergonomics (positioning of candidate and model), and scanning conduct will be evaluated. The candidate must demonstrate how to locate and recognise the structures to be blocked, the anatomical structures around the target structure, as well as the structures to avoid, or that may cause complications or side effects (vessels, other nerves, pleura, etc.). The candidate can describe different block techniques for the same nerve using in- or out-of-plane techniques, single-shot, and catheter techniques. For the use of double guidance, the candidate must be able to recognise / describe the muscle response according to the needle tip position relative to the nerve in the ultrasound image.
Commonly used blocks excluding neuraxial and paravertebral blocks will be evaluated.
Please note: It is not required to mention patient consent, laboratory, or patient history check prior to a block nor hygiene precautions if not explicitly requested. The ultrasound setting will be performed by the examiners and only adjusted if necessary. Do not waste demonstration time!
Part 3: Discussion of a clinical case
A common clinical case will be discussed (e.g., management of a hip fracture in an ASA IV patient: discuss anaesthesia and different perioperative analgesia techniques). The candidate must show competence in evaluating the basic patient risks and the risks deriving from surgery. Different plans for anaesthesia and perioperative analgesia (including both systemic and regional techniques) must be presented and the advantages and disadvantages of each must be discussed.
Please note: It is not required to mention patient consent, laboratory and patient history check prior to an anaesthesia block, nor hygiene precautions if not explicitly requested. Only ask for a coagulation laboratory if the history mentions the use of anticoagulants or if a neuraxial block is performed.
Do not waste examination time!
Part 4: Problem-solving of a regional anaesthesia-related complication
A typical regional anaesthesia-related case will be discussed, ranging from nerve damage to local anaesthetic systemic toxicity. The candidate must be able to recognise the problem from the case presented, make a differential diagnosis, and present the strategies for problem-solving including a treatment plan and an outcome estimation.
Exam rating: The candidate must pass all 4 parts for a successful EDRA Part II examination.
Cardinal mistakes that pose a permanent or life-threatening danger to the patient (e.g., transfixing the central cord) will result in a failed examination.
The candidate must accumulate sufficient points during each part of the examination in order to gain an overall pass mark. Wasting examination time by not answering or discussing the problem, adjusting settings on the ultrasound machine, or talking about steps like informed-consent, previous history, etc., when not asked to do so, will only lead to reduced examination time and a consequent low score.
Examiners will provide you with the information you need for your case and ask specifically if they want you to talk about a certain topic. They will guide you through the examination process and move to the next question when your allocated time is finished. You can assume that the patients agree to your regional anaesthesia technique and that you are blocking the correct site and that aseptic hygiene precautions are in place. Do not waste examination time!