King´s College Hospital, London, UK.
Regional anesthesia focused
NICE advisor in ultrasound regional anaesthesia. Co-author: "Guidelines in the use of ultrasound in regional anaesthesia" 2009.
Chairman and Founder of the London Society of Regional Anaesthesia.
Several publications in magazines in ultrasound regional anaesthesia .
Several Chapters in regional anaesthesia books, (UK, USA and Spain).
Two books in regional anaesthesia under ultrasound.
Pioneer in the use of learning curves into anaesthetics ( 2005).
Designer of an echogenic epidural needle: Rafa´s needle, Vygon.
Designer and programmer of anesthesialogbook.com.
Designer and programmer of www.lsora.com.
Comments a recent paper about the TAP Block
Børglum J, Maschmann C, Belhage B, Jensen K.
Acta Anaesthesiol Scand. 2011 Jul;55(6):658-63
A novel approach and refinement into the widely spread block called TAP block (transversus abdominis plane block) is described in this paper. It consists of four injections, two in each side, a subcostal approach plus a classic anterior low approach. The anatomical variability and the complexity of the innervations of the abdominal wall by intercostals nerves require an approach as it is described in this paper. With a sensible use of the local anaesthetic avoiding possible toxicity Professor Borglum aims to numb the entire abdominal wall. We share this approach in modern regional anaesthesia, letting the local anaesthesia to reach specific targets and the whole network of nerves that its involved not trying to focus in a single nerve that could be not the relevant one for the surgical site affected. This is a prospective cohort study of 25 patients, therefore conclusion cannot be taken widely but itis as follows: Although the combination of the two seem to work perfectly well in most of the cases a better pain relieve is obtained from the lower points injected (classic anterior TAP approach). We noticed in this paper that the total surgical times vary widely, meaning that there is a wide range of surgical procedures and probably differences in complexity and amount of pain obtained. We wonder if the four injections should be done before the patient waking up or at the first stage of recovery. Finally the blocks last a mean of 6 hours, and this is not in line with other papers published. Said that this works in line with our experience of anterior TAP blocks. We congratulate anyway Professor Borglum for the paper and for sharing with us his expertise.
Rafael Blanco MD
Interview with the expert
1- Which technique are you working in and what kind of tip can you give to our users?
I am currently working in thoracic wall blocks and my tip to understand these blocks is to go to an anaesthetic department and look at some dissections. This is the best way to understand the spaces that can be filled with local anaesthetic and its possible spread.
2- There are more and more people getting a high level in ecoanesthesia in the last years, but you began to be an ultrasound regionalist in 90´s... What do you think about the evolution of the technique in the 21st century?
I am very pleased with the interest that ultrasound regional anaesthesia has attracted into new trainees and anaesthetist. It confirms what we said ten years ago, that this technique came to last for a long time.
3- You developed an education system to learning ultrasound anesthesia with more efficiency: ‘Cusum’. What do you recommend to a beginner in this area?
From day one be very precise when recording your cases. Register into the website and get used to fill all your records. Input as much information as you can. It will allow you to understand and monitor your progression in regional anaesthesia and other subspecialties. Review your cases in monthly bases and check with your supervisors your concerns. Define what is success in your blocks or techniques with somebody senior and write it down in case you forget. Promote and use learning curves. It is more objective than a plain logbook.