FRCA Curriculum – Regional

Competence Source Curriculum Description
RA_BK_01 Basic Recalls/describes the anatomy relevant to regional and peripheral blocks identified [Cross ref basic sciences]
RA_BK_02 Basic Recalls the relevant physiology and pharmacology [including toxicity of local anaesthetic agents, its symptoms, signs and management, including the use of lipid rescue] [Cross ref basic sciences]
RA_BK_03 Basic Recalls the relevant physics and clinical measurement related to the use of nerve stimulators in regional anaesthesia [Cross ref basic sciences; physics and clinical measurement]
RA_IK_01 Intermediate Demonstrates understanding of basic sciences as applied to all regional anaesthetic blocks [Cross reference applied basic sciences]
RA_BK_04 Basic Discusses the advantages/disadvantages, risks/benefits and indications/contra-indications of regional blockade
RA_IK_02 Intermediate Recalls/discusses advantages and disadvantages, techniques and complications [including management] of a wide variety of blocks including, but not exclusively, major peripheral blocks of the limbs, some cranial nerve blocks and blocks used to treat chronic pain conditions [Cross ref pain medicine]
RA_BK_05 Basic Describes how to obtain consent from patients undergoing regional blockade
RA_BK_06 Basic Outlines the basic functions of an ultrasound machine [including physics [ref Basic Sciences], picture optimisation and probe selection] and how nerves to and in the upper limb can be identified using ultrasound
RA_IK_05 Intermediate Demonstrates an in-depth understanding of the principles of ultra sound guided nerve blocks including:

  • The principles of scanning including machine ergonomics, probe selection/handling and the use of acoustic couplant [ultrasound gel] to improve skin contact
  • The importance of the angle of insonation on visibility of structures [anisotropy] specifically related to nerves and tendons
  • The normal sonoanatomy of peripheral nerves and surrounding structures
  • The basic concepts of needling techniques relating to ultrasound guidance (in plane / out of plane)
  • Understanding and recognition of spread of local anaesthetic under ultrasound guidance, distinction between normal intraneural and intravascular injection
RA_BK_07 Basic Describes the principles of performing the following regional and local anaesthetic procedures:

  • Subarachnoid and Lumbar/caudal epidural blockade
  • Brachial plexus blocks: axillary, interscalene and supraclavicular
  • Other more distal upper limb blocks [elbow and wrist]
  • Lower limb blocks [femoral, sciatic and ankle]
  • Ilio-inguinal nerve blocks/penile blocks
  • Ophthalmic blocks [Cross reference to ophthalmic anaesthesia]
  • Intravenous Regional Anaesthesia [IVRA]
RA_BK_08 Basic Demonstrates understanding of the use of continuous epidural infusions and the need to prescribe correctly
RA_BK_09 Basic Recalls/discusses the complications of spinal and epidural analgesia and their management including, but not exclusively, accidental total spinal blockade and accidental dural tap and post-dural puncture headache
RA_BK_10 Basic Describes techniques and complications of other blocks listed in RA_BK_07
RA_BK_11 Basic Shows understanding of the principles of identification of correct anatomy including the use of nerve stimulators and ultrasound [Cross reference Ultrasound]
RA_BK_12 Basic Outlines the dangers of accidental intravenous administration of local anaesthetic drugs, signs, symptoms and management, including the role of lipid emulsion
RA_BK_13 Basic Outlines the management of incomplete or failed regional blockade including, where appropriate, the use of rescue blocks
RA_BK_14 Basic Demonstrates understanding of the methods of sedation used in conjunction with regional anaesthesia
RA_BK_15 Basic Recalls/describes absolute and relative contraindications to regional blockade
RA_BK_16 Basic Outlines the possible effects regional blockade will have on the patient, list and the theatre staff and how these may be managed
RA_BK_17 Basic Lists the advantages and disadvantages of regional anaesthetic techniques for post-operative analgesia
RA_BK_18 Basic Describes the problems and solutions to obtaining adequate post-operative analgesia in the ward or home [if discharged] setting when the regional anaesthetic wears off
RA_BK_19 Basic Understands the need to review patients or contact patient following regional anaesthetic techniques to ensure block has worn off and there are no residual complications
RA_BK_20 Basic Understand the necessity to document the procedure and any complications e.g. paraesthesia, vascular puncture, pneumothorax and record images / video clip if using ultrasound where appropriate or indicated
RA_BK_21 Basic Be aware of the use of information leaflets in the decision making process and in the reporting of problems or complications following discharge
RA_BK_22 Basic Recalls the relevant basic physics and clinical application of ultrasound to regional anaesthesia [Cross ref basic sciences; physics and clinical measurement] in respect of:

  • The components of an ultrasound machine
  • The interaction of ultrasound with tissues
  • Picture optimisation using hand movements, adjustment of depth, gain and focus
RA_IK_03 Intermediate Demonstrates understanding in the choice of local anaesthetic agents, opioids, use of additives and techniques of administration
RA_IK_04 Intermediate Outlines the principles of continuous catheter techniques for peripheral nerve blockade and for postoperative analgesia