Future directions in regional anaesthesia: not just for the cognoscenti

We thank Turbitt et al. for their recent editorial on rationalising teaching of block diversity 1. As regional anaesthesia fellows at a large London teaching hospital, we are both regional anaesthesia learners and, increasingly, regional anaesthesia teachers. We applaud the approach and, whilst the exact choice of blocks will doubtless generate debate, we believe the overall strategy of selecting a small number of blocks, and driving competence among as many consultants and trainees as possible, is compelling. However, the scale of the challenge should not be underestimated. We carried out a snapshot survey of anaesthetic consultants in seven acute Trusts covering 10 hospitals in London. Of 139 anaesthetic consultants at these Trusts, only 15 (10.8%) stated they could teach all seven of the plan A blocks under ultrasound guidance. Twenty-nine (20.9%) consultants felt they were not confident they could teach any of them and a further 12 (8.6%) felt they could teach only one of them. Only 24 (17.3%) consultants felt confident they could teach the erector spinae block (the newest of the blocks on the list). Training anaesthetic trainees and consultants in performing these blocks, in our region at least, is likely to be challenging on the basis of these results. Our results are not meant to undermine the 'plan A blocks' approach, but they do reflect the size of the problem faced. We believe experts in the field, as well as relevant societies and associations, should consider strategies to drive wider competence and make regional anaesthetic and analgesic approaches available for more patients.