Fellowship In Regional Anaesthesia
Duration
13 Months
Preamble:
Regional anaesthesia (RA) has become a vital component of perioperative care, pain management, and enhanced recovery protocols. Despite its growing importance, there is a paucity of structured training programs in India. This fellowship, offered by Yenepoya (Deemed to be University), is designed to provide comprehensive training in ultrasound-guided and peripheral nerve stimulator-assisted regional anaesthesia techniques. It aims to produce independent, confident, and evidence-based practitioners capable of delivering high-quality patient care.
Scope and need for starting the course:
With increasing demand for regional anaesthesia and acute pain management in trauma, orthopaedic, general, urologic, and paediatric surgeries, onco surgeries, as well as postoperative pain management, there is a pressing need to equip anaesthesiologists with specialized skills. This course bridges the gap between postgraduate education and practical expertise, supporting the institution's commitment to advanced medical education and quality healthcare.
Objectives/Outcomes
- PO1 - Perform a wide array of ultrasound-guided and nerve stimulator-assisted peripheral and truncal nerve blocks.
- PO2 - Demonstrate sound knowledge of applied anatomy, pharmacology, and equipment relevant to RA.
- PO3 - Integrate regional anaesthesia into perioperative care and acute pain services.
- PO4 - Participate in research, audits, and academic presentations.
- PO5 - Manage local anaesthetictoxicities , hematomas and block failures.
- PO6 - Lead a regional anaesthesia service in both teaching and non-teaching settings.
Eligibility for admission
Candidates with MCI/NMC-recognized postgraduate degrees in Anaesthesiology: MD, DNB, or DA.
Attendance Requirements
- Minimum 80% attendance in clinical and academic sessions.
- Active participation in teaching activities and emergency on-call services.
- Attendance at one national or regional workshop/conference related to regional anaesthesia is encouraged.
Course Content
Theory (Cognitive Domain)| Topic Area | Subtopics |
|---|---|
| Ultrasound & PNS Equipment |
• Physics of ultrasound (frequency, attenuation, resolution) • Machine knobology and image optimization • Understanding and identification of artifacts • Principles and applications of Doppler in RA • Cleaning and sterilization protocols for equipment |
| Applied Anatomy & Sonoanatomy |
• Surface and cross-sectional anatomy relevant to RA • Sonoanatomy of brachial plexus (interscalene, supraclavicular, infraclavicular, costoclavicular, axillary) • Sonoanatomy of lower limb nerves (femoral, sciatic, popliteal, saphenous, lumbar plexus) • Thoracic, abdominal wall, and paravertebral anatomy • Neuraxial sonoanatomy (spinal, epidural, caudal) |
| Applied Physiology |
• Pain pathways and modulation • Mechanisms of nerve conduction and blockade • Physiology of the autonomic nervous system in RA • Pathophysiology of nerve injury and regeneration |
| Applied Pharmacology |
• Pharmacokinetics and pharmacodynamics of local anaesthetics • Use and mechanisms of adjuvants (dexmedetomidine, clonidine, etc.) • Anticoagulation and regional anaesthesia guidelines • Sedative agents and their use during RA • Recognition and management of local anaesthetic systemic toxicity (LAST) |
| Pain Management |
• Principles of acute pain management with RA • Chronic pain mechanisms and RA-based interventions • RA in enhanced recovery after surgery (ERAS) protocols |
| Specialty-Specific RA |
• RA strategies for orthopaedic surgeries (limb blocks, neuraxial) • RA for general surgery including abdominal blocks (TAP, rectus sheath) • Paediatric regional anaesthesia considerations and techniques • Urologic and gynecologic procedures: caudal, spinal, epidural • Thoracic surgery: paravertebral, erector spinae, intercostal blocks |
| Complications |
• Recognition and prevention of nerve injury • Causes and troubleshooting of block failure • Infection control and aseptic techniques • Diagnosis and management of LAST • Pneumothorax and other block-specific complications |
| Ethics & Communication |
• Obtaining valid informed consent • Clear communication of risks, benefits, and alternatives • Ethical dilemmas and medico-legal responsibilities • Accurate documentation practices |
| Research Methodology |
• Framing research questions and objectives • Conducting literature reviews • Study design (RCTs, observational studies, audits) • Basic biostatistics and interpretation of data • Manuscript writing and ethical publishing |
| Skill Area | Techniques |
|---|---|
| Basic Skills | Probe handling, image optimization, needle control |
| Block Techniques | Upper/lower limb, truncal, neuraxial blocks (USG & PNS) |
| Advanced Blocks | Paravertebral, QL, lumbar plexus, parasacral |
| Continuous Catheter Use | Insertion, securing, managing complications |
| Simulation & Cadaver Lab | Phantom models, quarterly cadaver-based dissection |
| Emergency Management | LAST protocol, block failure rescue strategies |
- Communicating risks and benefits with patients
- Ethical practice, documentation, and consent
- Teamwork and leadership in operating theatres and acute pain services
- Lifelong learning through self-audit and literature updates
Program Outcomes
Core Clinical Competencies| PO# | Program Objectives | Program Specific Objectives |
|---|---|---|
| PO1 | Develop knowledge in sonoanatomy and regional techniques | Demonstrate comprehensive knowledge of ultrasound anatomy and peripheral nerve blocks |
| PO2 | Perform regional blocks safely and independently | Carry out basic and advanced RA procedures with precision and confidence |
| PO3 | Ensure safe and ethical patient interaction | Explain procedures, manage expectations, and obtain informed consent |
| PO4 | Manage RA-related complications | Recognize and respond to LAST, block failure, or inadequate analgesia |
| PO5 | Apply RA in broader perioperative context | Integrate RA into ERAS pathways and multimodal analgesic strategies |
| PO# | Program Objectives | Program Specific Objectives |
|---|---|---|
| PO6 | Lead anaesthesia services and initiatives | Organize and guide RA services across diverse clinical contexts |
| PO7 | Engage in quality improvement and audits | Plan and execute departmental audits and improvement plans |
| PO8 | Foster research culture | Conduct and publish RA research in indexed journals |
| PO9 | Promote peer and student learning | Mentor junior colleagues and lead educational sessions |
| PO10 | Uphold professionalism and ethics | Demonstrate integrity, accountability, and commitment to best practices |
Teaching - Learning Modalities
- Weekly didactic sessions and case-based discussions
- Journal clubs (once a month)
- Hands-on training under supervision (Monday–Saturday)
- Simulation and phantom-based skill development
- Cadaveric anatomy workshops (quarterly)
- Logbook and e-portfolio with weekly reflections
- Regular internal assessments and feedback
- Teaching undergraduate/postgraduate trainees
Research Requirements
- Participation in two clinical audits
- Involvement in at least one research project with presentation/poster at a national/regional conference
- Submission of one manuscript to a peer-reviewed indexed journal (Scopus/PubMed preferred)
Assessment
Formative Assessment- Monthly clinical performance reviews with structured feedback
- Block skill assessment through Direct Observation of Procedural Skills (DOPS)
- Mini-Clinical Evaluation Exercises (Mini-CEX) during perioperative patient encounters
- Multisource feedback (faculty, peers, nursing staff) every quarter
- Case-based discussions and logbook evaluations
- Participation in teaching activities, journal clubs, and simulations
- Self-reflection entries in e-portfolio reviewed monthly by mentor
Summative Assessment
- Theory Examination (100 marks) – Short notes (10 × 10 marks)
- Topics: Equipment, anatomy, physiology, pharmacology, surgical RA strategies, complications, recent advances
- Practical Examination (100 marks): Long case (30 min, 40 marks), two short cases (15 min each, 30 marks), structured viva (30 marks)
Pass Criteria: Minimum 45% in each component (theory & practical); aggregate must exceed 50%
Reference Books
- Hadzic’s Textbook of Regional Anesthesia and Acute Pain Management
- NYSORA RA Compendium
- Raj’s Practical Management of Pain
- Journals: RAPM, other relevant regional anaesthesia journals and review articles
Any Other Information
Fellows will receive mentorship under faculty trained in regional anaesthesia. Completion certificate will be issued upon successful fulfillment of academic, clinical, and assessment criteria. Research involvement is mandatory.
Clinical Procedures Log
| Procedure | Observed | Assisted | Performed Independently |
|---|---|---|---|
| Probe handling and image optimization | |||
| Interscalene block | |||
| Supraclavicular block | |||
| Infraclavicular block | |||
| Axillary block | |||
| Femoral nerve block | |||
| Sciatic nerve block | |||
| Adductor canal block | |||
| Popliteal block | |||
| Transversus abdominis plane (TAP) block | |||
| Rectus sheath block | |||
| Ilioinguinal/iliohypogastric block | |||
| Paravertebral block | |||
| Erector spinae plane block | |||
| Lumbar plexus block | |||
| Parasacral block | |||
| Caudal epidural block | |||
| Spinal anaesthesia | |||
| Epidural anaesthesia | |||
| Continuous catheter placement | |||
| Block rescue techniques | |||
| Management of LAST | |||
| Ultrasound-guided vascular access | |||
| Pericapsular Nerve Group (PENG) block | |||
| RISS (Retrolaminar In-plane Sub-Splenius) block | |||
| Quadratus Lumborum (QL) block | |||
| Costoclavicular block | |||
| Ankle block |
