ESRA Educational Grant – Our experience from St George’s University Hospital

During our anaesthetic training in Greece , we have realized how important regional anaesthesia proved to be for our daily clinical practice. There is nothing more satisfying than being able as an anaesthetist to deliver the best analgesia to patients. Therefore, we had a personal goal to visit a department that offers an advanced training in regional anaesthesia; we achieved this goal by successfully applying for the ESRA Educational Grant. During our research we realized that St George’s University Hospital in London would be ideal, since it is a major trauma centre with an extensive regional anaesthesia curriculum. We contacted Dr Andrzej Krol (Regional Anaesthesia Lead and Program Director) who has kindly accepted us for a 3-month training. We were thrilled to start working in a centre of excellence in regional anaesthesia.

To be honest, our experience in St George’s exceeded our expectations. St George’s Hospital, founded in 1733, is one of the UK’s largest teaching hospitals and one of the largest hospitals in Europe. As a major acute hospital, St George’s Hospital also offers specialist care for the most complex injuries and illnesses, including trauma, neurology, cardiac care, renal transplantation and cancer care. The Anaesthetic Department has 140 consultants and 40 trainees. There are 30 operating theatres with a lot of ultrasound machines. There, we had the opportunity to perform a wide variety of peripheral nerve blocks (upper, lower limb, trunk blocks) and to build up our skills in peripheral nerve catheters insertion. What raised our interest particularly, was the specific clinical pathway for patients undergoing major limb amputations, where the sciatic nerve catheter was inserted in more than 90% of the patients and was kept for at least 5 days, reflecting the high quality of regional analgesia that is provided in this hospital. It was also valuable learning for us working within the acute pain team and learning the pathways of providing post-operative analgesia for the patients. We felt honoured being active members of the Regional Anaesthesia Team, at St George’s hospital.

From the left: Dr Martin Marinov, Consultant in Anaesthesia and Pain Medicine, Dr Georgia Efstathiou ESRA Fellow, Dr Andrzej Krol, Consultant in Anaesthesia and Pain Medicine

Except for our clinical practice, Dr Krol assigned us with several projects, such as writing a patient information leaflet for the ambulatory spinal and upper limb blocks for Day Surgery, to undertake an oral presentation in the department about Acute Compartment Syndrome and Regional Anaesthesia and to make a quality improvement survey on the safe practice of regional anaesthesia. Also, we had the opportunity to practice several procedures in the pain clinic, such as performing lumbar, caudal epidurals, diagnostic peripheral nerve blocks and RF and facet joints/ medial branch blocks. Furthermore, we had the chance to attend the first hand on course on regional anaesthesia after the pandemic, organised by the faculty of East Surrey Hospital in collaboration with the Anaesthetic Department of St George’s Hospital. It was an excellent 3-day course which included a cadaver workshop, an ultrasound demonstration workshop and live interactive demonstration from theatres run by very enthusiastic, knowledgeable and helpful faculty.

From the left: Andreas Kostroglou, ESRA Fellow, Georgia Efstathiou ESRA Fellow, Dr Georgios Giannitopoulos, Consultant Anaesthetist

At St George’s hospital, we found a very pleasant working environment. The consultants were always very patient and available to teach us even after long and demanding days or under stressful situations. Moreover, the trainees and trauma/regional fellows were very friendly and their support was invaluable throughout our training. All the other doctors, nurses, the acute pain team and the administration staff were also very kind and welcoming.

We made strong relationships during this 3-month period and we are very grateful to all the anaesthesia staff, and particularly to Dr Krol, our mentor, for ensuring that this opportunity was rewarding and meaningful to us, for all the advice and encouragement and for making our training so pleasant.

We are immensely grateful for this 3-month training and would like to encourage fellow anaesthetists to apply for the ESRA Educational Grant. By taking part in such a programme, apart from the extensive training in regional anaesthesia, anaesthetists are able to build a professional network across countries and experience different working environments and healthcare systems.

Finally, we would like to thank the ESRA team for all the work they did to make this opportunity possible, even during a world pandemic, and for the support they provided throughout our placement. We are also very grateful to our colleagues in the previous department where we completed our training (Attikon University Hospital of Athens) for supporting us during our residency and giving us the essential credentials in order to be able to apply successfully for the ESRA Educational Grant.