Author(s): ,
Beard , L.*
Hereford County Hospital, Anaesthetics, Hereford, United Kingdom
Budd , J.
Hereford County Hospital, Anaesthetics, Hereford, United Kingdom
ESRA Academy. Beard L. Sep 13, 2017; 190899; 226 Topic: REGIONAL ANAESTHESIA (RA) IN SPECIFIC SUBPOPULATIONS
Dr. Laura Beard
Dr. Laura Beard

Access to Premium content is currently a membership benefit.

Click here to join ESRA or renew your membership.

Discussion Forum (0)
Rate & Comment (0)

Background and Aims:

Serratus anterior plane (SAP) blocks can provide paraesthesia to the hemithorax and analgesia for up to 12 hours.1 The anaesthetic department at Hereford County Hospital wanted to introduce this relatively new block for the management of acute pain in patients with rib fractures because of its reduced side effect profile, relative ease of insertion and reduced requirement for post procedure monitoring when compared to paravertebral and epidural analgesia. 


A training programme was required that could accommodate a varied skill and experience base and ensure that all anaesthetists undertaking on-calls could safely and competently perform the block.


The traditional ‘see one, do one, teach one’ approach was not appropriate for our ‘students’, so we developed a programme that included simulation of the block to enhance acquisition of the essential skills necessary for this ultrasound guided block.2

The teaching programme we developed featured:

  • Demonstration of ultrasound anatomy on live model.
  • Use of ultrasound phantoms to practice in plane ultrasound and needle technique. (Image 1)
  • Catalogue of ultrasound images from different patients to aid with recognition of anatomy. (Image 2)
  • Supplementary reading material (available on trust intranet).
  • Opportunity to perform SAP block on consented patients undergoing breast surgery.

Image 1:
Image 1: Ultrasound Phantoms

Image 2:
Image 2 Catalogue Conclusions:

Simulation in regional anaesthesia allows for hands on, repetitive experience, with immediate feedback and no risk of patient harm. Studies have shown that anaesthetists who have received training on proper ultrasound handling and needle coordination were more successful in block performance on real patients.3

1.     R. Blanco, T. Parras, J. G. McDonnell, A. Prats-Galino. Serratus plane block: a novel ultrasound-guided thoracic wall nerve block. Anaesthesia 2013; Volume 68, Issue 11: 1107–1113.
2.     Kessler J, Wegener J. Teaching concepts in ultrasound-guided regional anaesthesia. Curr opin Anesthesiol 2016, 29:608-613. 
3.     Ankeet D. Simulation in teaching regional anesthesia: current perspectives. Local and Regional Anesthesia 2015:8 33–43



Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings