Royal Victoria Infirmary

Establishment

The RVI is a large tertiary referral centre in the centre of Newcastle upon Tyne. Of particular important is the fact this is a major trauma centre which also houses one of the most progressive regional anaesthesia departments in the UK.

We have approximately 20 consultants and SASG doctors who provide a full range of regional anaesthesia techniques. A subset of these individuals are involved in the running of the NUSGRA organisation and website (www.nusgra.co.uk), which provides educational materials in regional anaesthesia, as well as running two national cadaveric ultrasound courses per year.

We have a well-established block room in the day case theatre area, where awake surgery is the standard of care for elective hand and wrist surgery as well as all plastics hand trauma. Additionally, this area is also utilised for the insertion of nerve catheters for a variety of indications, mainly trauma but also for prolonged analgesia for inpatient physiotherapy.

Scope of work

The RVI provides the majority of adult and paediatric surgical services, exceptions being cardiothoracic surgery, transplant, vascular, urology and elective hip / knee arthroplasty, which are undertaken at our partner site, the Freeman hospital.

Regional anaesthesia is widely employed around the RVI in many specialties, including orthopaedic trauma, shoulder, breast, and plastic surgery including major free flaps as well as hand surgery. We work very closely with our acute pain team to innovate and expand the remit of regional anaesthesia. With regards to nerve catheters for trauma patients, in a 12 month period we placed 154 paravertebral and 300 fascia iliaca catheters, in addition to smaller numbers of erector spinae, femoral, interscalene and supra/infra clavicular catheters. These figures do not include catheters placed for elective surgery.

Since 2012, we have run an awake shoulder surgery list every week for high GA risk patients, employing interscalene catheter infusions which patients are discharged home with on the day of surgery. This pioneering service has revolutionised high risk open shoulder surgery in our region, and was shortlisted for a National award. We also offer awake breast surgery to high risk patients on a case by case basis.

In addition to this, we can offer a multitude of non clinical opportunities for our advanced trainees in regional anaesthesia:

Teaching – we teach on local courses as well as running national NUSGRA cadaveric courses. We were selected as a centre to hold the RA-UK / ESRA E-day in January 2018, which we will be repeating next year, and we will continue to provide faculty for the national SonoUK Festival of Ultrasound, which held its first course in April 2018.

Publications – the regional anaesthesia department actively contributes to peer reviewed journals with contributions in original research, case reports, technical reports and letters of opinion. We are soon to submit a manuscript highlighting our experience of paravertebral catheters techniques for chest trauma, of which we perform more than any other UK site.

Research – We are actively pursuing funding to undertake original research in the role of and effectiveness of regional anaesthetic techniques in breast surgery.

Service development – A business case is in progress to set up a second block room to service orthopaedic / trauma theatres and to provide an alternative location to undertake catheter techniques for acute pain and trauma.

Innovation – We have recently incorporated spirometry into a novel scoring system for chest trauma patients, and there is opportunity to further develop the clinical pathway for these patients and to undertake audit or research in this area. Furthermore, we are one of only a few sites where anaesthetic assistance are encouraged to undertake ultrasound guided infrainguinal fascia iliaca blocks in hip fracture patients. This service depends on us delivering the set teaching program, as well as running a cadaveric course specifically configured to teach fascia iliaca blocks. We embrace new technology and there are opportunities to be involved in the creation of new online learning materials and to help create and develop newer ways of connecting with our patients, an example being the recent adoption of patient SMS messaging services.

Duties

•The post holder would be expected to take part in departmental audit and educational opportunities that are available. They would be expected to work within the framework of clinical governance.
•Weekday elective work will be worked flexibly to maximise clinical exposure to regional anaesthesia.
•The post holder is required to conduct a proportion of their elective clinical work under distant supervision.
•The advanced regional anaesthesia trainee will be expected to develop a quality improvement/research project related to regional anaesthesia and to maintain regional anaesthesia database.
•Presentation in local, national and international meetings and conferences is  encouraged.
•The post holder is encouraged to participate in teaching opportunities made available

Post

This six month post is available to anaesthetic trainees on the Northern Deanery Rotation in Anaesthesia who are in possession of the FRCA.  Trainees are expected to complete higher regional anaesthesia competencies before applying for advanced regional anaesthesia placement. The post will be for 6 months to dovetail with the training rotation.

This EWTD compliant post will involve night shift work on weekdays and weekend shifts.

It is anticipated that the Advanced Trainee in Regional Anaesthesia will gain a broad and unique experience in all aspects of surgery requiring regional anaesthesia.

For further information please contact the clinical lead for Regional Anaesthesia at the RVI, Dr Jonathan Womack.