Tuesday, July 28, 2009

Block expert wannabees..

Peripheral nerve blocks are certainly the in thing in anaesthesia. The option of having surgery without giving general anaesthesia is an interesting idea. Of course , it is not suitable for all surgeries but definitely for limb and anything away from the mid trunk. It needs a lot of skill and to reach that level of skill one needs a lot of patience. Obviously , male anaesthetists are more inclined towards this technique compared to our females counterpart. This may not be totally true but then agia , its always the man having the upper advantage when you talk about "fine" skills..
I was converted into this "sect" of anaesthesia long ago when i was introduced to it by Dr Salleh ( at that time he just graduated as a specialist) on one of my junior calls in HKL. Later on I met Jeya in Selayang and he further embraced me further bout its benefits. The only way to learn doing blocks were just trying it again and again.
Of course , when i came to UM ; i was introduced to Dr Ling.. the MASTER SIFU of peripheral nerve blocks. He gets so excited everytime there is a block going on and i know , if it was possible he would avoid giving GA altogether !! FYI.. i had the opportunity to perform "extraordinary" blocks with him that our case report was accepted in the coming EuropeanRegional Anaesthesia conference in Austria !! ( but that will be another blog entry in the near future.. :)

And when i thought i was comfortable with the nerve stimulator technique , came the ultrasound guided technique. I was initially a bit reluctant to convert myself ( the usual trend of practices in anaesthesia) . I would have thought that nerve stimulation technique was superior enough but considering the safety that ultrasound visual offer it was difficult to resist.Things u gamble may not be wise after all after seeing how close vital structures are to the neerve bundles under ultrasound guidance! It was so easy to cause a lot of unecessary tissie and possible functional damage if one is not careful. However , it is not for the impatient ones as the whole procedure may take time to perform. Good communication with provisions of time management must be applied to ensure the learning curve is steep.
Ultrasound visuals of muscles and nerves need a lot of imagination and people teeling you which structure is what. It can be really annoying doing the scan an unable to identify which is what !
"There.. Mafeitz see.. you are there already.. "
"Where Ling ?"
There your needle.. see that. thats the nerve.."
Which one Ling ? I cannot see... "

aiiyaaaa.. that one laaah !"
" Ling KU!! Tak nampak pun ??"

" Yeaaah.. give the local..see the spread ?"
" Huh ????"

" Haiiyaaahhh !!"

No comments: