Peripheral Nerve Block Procedures Classification

Overview
The NYSORA classification of regional anesthesia procedures (See Techniques) to basic, intermediate and advanced is based on their clinical applicability, complexity of their performance, the frequency of their use in clinical practice in the US and their potential for complications. This classification can serve as a useful guide to structuring a regional anesthesia rotation for anesthesiology residents and fellows. Additionally, the breakdown of regional techniques in these three categories can be used to tailor regional anesthesia workshops to the needs and levels of individual trainees.
Basic Peripheral Nerve Block Procedures
Basic nerve block procedures are technically easy to perform, have a low risk of complications and have a wide clinical applicability. These procedures should be a part of the armamentarium of every practicing anesthesiologist. Basic nerve block techniques are indeed frequently practiced US-wide, and ample expertise is present in most residency programs to allow adequate training of residents. The current requirements by the RRC (residency review committee) for training in nerve blocks consists of 40 nerve block procedures which should be sufficient to allow sufficient training in these techniques.
Intermediate Peripheral Nerve Block Procedures
While some of the intermediate regional anesthesia procedures are relatively simple to perform and teach, their complexity and potential for complications is greater than those of the basic block techniques. In addition, far fewer residents graduate with sufficient expertise to successfully implement them in their clinical practice. These techniques are best mastered by spending 1-2 months in a well structured and mentored elective peripheral nerve block rotation during residency training or fellowship in regional anesthesia. Alternatively, provided adequate proficiency in the basic nerve block techniques is achieved, expertise in these procedures can be attained by additional self-studying and participating in various regional anesthesia workshops.
Advanced Peripheral Nerve Block Procedures
These are highly specialized procedures most of which requiring a significant expertise in the basic and intermediate nerve block procedures for their implementation. Advanced nerve block procedures are either deeper nerve blocks, or blocks that require specialized equipment and insertion of indwelling catheters for continuous infusion of local anesthetic. It is only a few trainees that can be master advanced nerve blocks by spending a 1-2 month dedicated training in a mentored nerve block rotation during senior years of anesthesia residency training. However, most trainees require a 6-12 month fellowship in order to acquire respectable expertise.
References
  • Hadzic, Vloka et al. Reg Anesth Pain Med 1998:23:241-6.

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DISCLAIMER: The material presented on this Web page has not been peer-reviewed. The indications, techniques and dosages on this Web page have been recommended in the medical literature and/or conform to OUR clinical practice. The medications and equipment have not necessarily been approved by the Food and Drug Administration (FDA) for use in the techniques and dosages for which they are recommended. The package insert for each drug and/or equipment should be consulted for use and dosage as recommended by the FDA. Because standards, practices and recommendations change, it is advisable to keep abreast of revised recommendations, particularly those concerning new drugs and techniques. While the techniques and dosages described are successfully used in our practice, they should be followed with a discretion since their complications may be dependent on the operator, patient and/or other accompanying clinical circumstances. The development and maintenance of this web page has not been supported by any pharmaceutical or medical manufacturing industry. The medications and/or equipment discussed in the web page is shown solely for teaching purposes. Similar equipment or medications from other manufacturers may produce similar clinical results to ours.