steven rhondeau md co-founder, alliance for international
TRANSCRIPT
Steven Rhondeau MD
Co-founder, Alliance for International Medicine
Adjunct Assistant Professor Department of Surgery
Center for Global Surgery
University of Utah School of Medicine
PARTNERSHIP
SUSTAINABLE
MEANINGFUL
PRACTICAL
Introducing Ultrasound Guided Regional Anesthesia in Resource-Restricted Countries: The AIM Experience
Steven Rhondeau MD
Co-founder, Alliance for International Medicine
Adjunct Assistant Professor Department of Surgery
Center for Global Surgery
University of Utah School of Medicine
FEMORAL/ SCIATIC
ABDOMINAL WALL
BRACHIAL PLEXUS
MOST DIFFICULT
MODERATE
LEAST COMPLEX
Date of Surgery
Age/Gender
Surgical Procedure
Regional Block Performed
Level of Difficulty
Postoperative Pain Score
Complications
Additional Annotations
Nombre/ Fecha Edad/Sexo Cirugia Bloque Regional Dificultad Cateter de Nervio Grado de Dolor Complicaciones Notas
J.S.G / 02-11-18 13 / MFRACTURA DE TALLO VERDE DE CUBITO Y RADIO DERECHO BLOQUEO INFRACLAVICULAR DERECHO 1 - 0 ANTECEDENTES : ALERGIA PNC
F.F.M / 02-11-18 59/FFRACTURA DE DIAFISIS DE HUMERO DERECHO BLOQUEO SUPRACLAVICULAR DERECHO 2 - 1 ANTECEDENTES : HIPOTIROIDEA/DM2, RAM: METAMIZOL
J.C.M/ 07-11-18 66 / M INJERTO VASCULAR BLOQUEO INTERESCALENICO DERECHO 2 - 3BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO/ ANTECEDENTE: ERC-5
N.C.B/ 08-11-18 64/ M FRACTURA DE HUMERO IZQUIERDOBLOQUEO INFRACLAVICULAR+ INTERESCALENICO IZQUIERDO 2 - 0
J.R.N /08-11-18 05/ MFRACTURA DE RADIO Y CUBITO IZQUIERDO BLOQUEO AXILAR IZQUIERDO 1 - 0 BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO
J.M.L /13-11-18 17 /M FRACTURA DE RADIO DISTAL BILATERAL BLOQUEO INFRACLAVICULAR BILATERAL 2 1 BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO
J.M.L / 15-11-18 17 /M FRACTURA DE RADIO DISTAL BILATERAL BLOQUEO INFRACLAVICULAR DERECHO 1 - 1BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO/ REEINGRESO A SALA DE OPERACIONES PARA LIBERACION DE TUNEL CARPIANO
M.A.R / 15-11-18 62/ F FRACTURA HUMERO PROXIMAL DERECHO BLOQUEO INTERESCALENICO DERECHO 1 - 0
G.O.R/ 16-11-18 60/ F FRACTURA DE CUPULA RADIO IZQUIERDO BLOQUEO INFRACLAVICULAR IZQUIERDO 2 - 0 ANTECEDENTES : HTA/OBESIDAD
J.N.G / 16-11-18 52/ MFRACTURA DE DIAFISIS DE HUMERO DERECHO
BLOQUEO INTERESCALENICO + SUPRACLAVICULAR DERECHO 2 0 ANTECEDENTES : SECUELA DE POLIOMIELITISS+ MPVIMIENTOS COREICOS
F.R.Z / 20-11-18 50/ MFRACTURA DE DIAFISIS DE RADIO IZQUIERDO BLOQUEO INFRACLAVICULAR IZQUIERDO 1 0
F.I.D / 22-11-18 14/ M FRACTURA DE HUMERO IZQUIERDO BLOQUEO INTERESCALENICO IZQUIERDO 1 0 BAJO ANESTESIA GENERAL BALANCEADA - BLOQUEO ANALGESICO POSOPERATORIO
M.V.V / 26-11-18 22/ M FRACTURA EXPUESTA HUMERO DERECHOBLOQUEO INTERESCALENICO + SUPRACLAVICULAR DERECHO 1 1
Collected data for 14 months
No blocks were performed for 3 months
135 UGRA blocks performed
5 were partial/incomplete blocks
No failed blocks
No complications
LOWER EXTREMITY BLOCKS: 22
ABDOMINAL BLOCKS: 4
UPPER EXTREMITY BLOCKS: 109
BLOCK DIFFICULTY SCALE
1 — Landmarks/needle easily identified and visualized during block
2 — Landmarks/needle mildly difficult to ID and visualize during block
3 — Landmarks/needle moderately difficult to ID and visualize during block
4 — Landmarks/needle very difficult to ID and visualize during block
5 — Block abandoned due to inability to identify landmarks and/or needle
LOWER EXTREMITY BLOCKS: 1.81
ABDOMINAL BLOCKS: 1.00
UPPER EXTREMITY BLOCKS: 2.67
PATHWAYS
PRE-MISSION TEACHING —> WORKSHOPS
CULTURAL BARRIERS
STANDARDIZED INTERNATIONAL GUIDELINES
SURGEON SUPPORT
BLOCKS ABANDONED EARLY
PERPETUATION OF PRACTICES/PROCESSES
LACK OF PROTOCOLS
RESIDENTS STAYING IN PIURA
PHYSICIANS COMING TO PIURA TO LEARN
ATTRACTING TOP RESIDENTS TO TRAIN
MEDICAL COMMUNITY WORKING TOGETHER TO RAISE THE STANDARD OF CARE
REGIONAL CENTER OF EXCELLENCE
LOCAL ANESTHETIC $0.60
20 cc SYRINGE $0.18
ULTRASOUND NEEDLE $1.53
NERVE CATHETER $6.00
NON-OPIOID PAIN MEDICATIONS
IV MAGNESIUM $2.94
IV KETOROLAC $0.88
ORAL GABAPENTIN $0.05