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1
CME COURSE – UPPER EXTREMITY BLOCKS PART I
Expires After: Does not Expire

https://nysoralms.com/wp-content/uploads/2020/06/NYSORA-CME-PROMO.psdUE-I-sq-copy-400x400.jpg

Course Fee: $ 250.00
– Number of CME credits: 5 AMA PRA Category 1 or ANCC credits™
– Released: 15 June 2020
– Last updated: 15 June 2020
– Expiration date: 15 June 2021
– Estimated time to complete course: 5 hours

Course content includes 4 sessions:

– Interscalene Brachial Plexus Block
– Supraclavicular Brachial Plexus Block
– Infraclavicular Brachial Plexus Block
– Costoclavicular Brachial Plexus Block

Step-by-step intuitive study material

Each session is divided into 6 lessons that will allow you to learn about performing Interscalene, Supraclavicular, Infraclavicular, and Costoclavicular Brachial Plexus Blocks guided by ultrasound. The lessons included in each session are Functional Anatomy, Sensory Block Distribution, Landmarks and Patient Position, Technique, Local Anesthetic Choice, and Tips & Algorithm.

At the end of the course material, you will be required to complete a Knowledge Assessment test based on the coursework and achieve 80% pass rate to successfully complete the activity for AMA PRA Category 1 credit or ANCC credits™.

Jointly provided by NYSORA and Postgraduate Institute for Medicine

This activity is suitable for Clinicians, Residents, Fellows, Nurses and other health care and health industry professionals

Educational Objectives:

After completing this activity, the participant should be better able to:
– Identify the brachial plexus anatomy needed to perform upper extremity blocks.
– Follow the instructions to perform an interscalene, supraclavicular, infraclavicular, and costoclavicular blocks, including:
A. Patient positioning
B. Transducer placement
C. Scanning technique
D. Needle insertion
– Match the brachial plexus techniques with the proper indications
– Troubleshoot commonly encountered difficulties during brachial plexus blocks, and apply correct strategies to solve them
– Select the type, concentration, and volume of local anesthetic to match the analgesic objectives

Faculty:

Admir Hadzic, MD, PhD
Professor of Anesthesiology
Director, NAICE (North American Institute for Continuous Education)
Director, NYSORA Continuing Medical Education
Consultant, Department of Anesthesiology,
Ziekenhuis Oost-Limburg
Genk, Belgium

 

Catherine Vandepitte, MD, PhD
Consultant, Department of Anesthesiology,
Ziekenhuis Oost-Limburg
Genk, Belgium

 

 

 

 

Joint Accreditation statement:

 

 

 

 

 

 

 

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and NYSORA. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 5 contact hours.

Disclosure of Conflict of Interest:

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Admir Hadzic, MD, PhD:
Consulted and advised for Philipps, Pacira and BBraun Medical
Industry-sponsored research include Pacira Pharmaceuticals and Heron Therapeutics
Dr. Hadzic receives royalty income from BBraun Medical.
He is a co-owner of MedXpress.pro, an intellectual property and medical device manufacturing entity, and NYSORA and NextLevelCME.com, educational entities.

Catherine Vandepitte, MD, PhD:
Receipt of grants/research supports from Pacira Pharmaceuticals

Planners & Managers:
The PIM and NYSORA planners and managers have nothing to disclose

Disclosure of Unlabled Use:

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer:

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management.  Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

System Requirements

You can access your CME courses from various devices and platforms, on both PC and Mac desktops / laptops, as well as Android and iOS mobile devices. Our system requirements for these follow below.

Minimum System Requirements

  • The latest ChromeFirefoxSafariEdgeOperaor IE11 for desktop/laptop
  • A broadband connection with a minimum speed of 5Mbit or 800kbps
  • Please note that Flash Player is not required

PC Specific Requirements

  • Platform: Windows 8 or higher with the latest updates installed
  • RAM: 4GB or more
  • Video: Graphics output capability
  • Sound: Sound output capability

Mac Specific Requirements

  • Platform: Mac OS X 10.12 or higher with the latest updates installed
  • RAM: 4GB or more
  • Video: Graphics output capability
  • Sound: Sound output capability

Mobile Specific Requirements

  • iOS 11.0 and above
  • Android 5.0 and above

Mobile browsers: Safari or Chrome on iOS and Chrome on Android.

What Browser am I Using?

To find out more about your specific system, this site will tell you which browser and OS you’re currently using.

To watch courses, we recommend using Google Chrome. You can download Chrome for free here.

Contact:

NYSORA: Email info@nysora.com

PIM: www.pimed.com

 

2
CME COURSE – UPPER EXTREMITY BLOCKS PART II
Expires After: Does not Expire

https://nysoralms.com/wp-content/uploads/2020/06/NYSORA-CME-PROMO.psdUE-II-sq-copy-400x400.jpg

Course Fee: $ 250.00
– Number of CME credits: 5 AMA PRA Category 1 or ANCC credits™
– Released: 15 June 2020
– Last updated: 15 June 2020
– Expiration date: 15 June 2021
– Estimated time to complete course: 5 hours

Course content includes 4 sessions:

  • The Shoulder Block  
  • Axillary Brachial Plexus block  
  • Blocks Above the Elbow  
  • Wrist Block

Step-by-step intuitive study material

 

Each session is divided into 6 lessons that will allow you to learn about performing the Shoulder Block, Axillary Brachial Plexus Block, and Selective Nerve Blocks above and below the elbow. The lessons included in each session are Functional Anatomy, Sensory Block Distribution, Landmarks and Patient Position, Technique, Local Anesthetic Choice, and Tips & Algorithm.

At the end of the course material, you will be required to complete a Knowledge Assessment test based on the coursework and achieve 80% pass rate to successfully complete the activity for AMA PRA Category 1 credit or ANCC credits™.

Jointly provided by NYSORA and Postgraduate Institute for Medicine

This activity is suitable for Clinicians, Residents, Fellows, Nurses and other health care and health industry professionals

Educational Objectives:

After completing this activity, the participant should be better able to:

  1. Identify the anatomy of the terminal branches of the brachial plexus needed to perform distal upper extremity blocks.
  2. Follow the instructions to perform a shoulder block, axillary brachial plexus block, peripheral nerve blocks above the elbow, and a wrist block, including:
    1. Patient positioning
    2. Transducer placement 
    3. Scanning techniques 
    4. Needle insertion 
  3. Match the distal blocks of the upper extremity with the proper indications.
  4. Troubleshoot commonly encountered difficulties during distal blocks of the upper extremity, and apply correct strategies to solve them.
  5. Select the type, concentration, and volume of local anesthetic to match the analgesic objectives.

Faculty:

Admir Hadzic, MD, PhD
Professor of Anesthesiology
Director, NAICE (North American Institute for Continuous Education)
Director, NYSORA Continuing Medical Education
Consultant, Department of Anesthesiology,
Ziekenhuis Oost-Limburg
Genk, Belgium

 

Catherine Vandepitte, MD, PhD
Consultant, Department of Anesthesiology,
Ziekenhuis Oost-Limburg
Genk, Belgium

 

 

Joint Accreditation statement:

 

 

 

 

In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and NYSORA. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Physician Continuing Medical Education
The Postgraduate Institute for Medicine designates this enduring material for a maximum of 5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 5 contact hours.

Disclosure of Conflict of Interest:

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers, and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

Admir Hadzic, MD, PhD:
Consulted and advised for Philipps, Pacira and BBraun Medical
Industry-sponsored research include Pacira Pharmaceuticals and Heron Therapeutics
Dr. Hadzic receives royalty income from BBraun Medical. He is a co-owner of MedXpress.pro, an intellectual property and medical device manufacturing entity, and NYSORA and NextLevelCME.com, educational entities

Catherine Vandepitte, MD, PhD:
Receipt of grants/research supports from Pacira Pharmaceuticals

Planners & Managers:
The PIM and NYSORA planners and managers have nothing to disclose

Disclosure of Unlabled Use:

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications. The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer:

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management.  Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

System Requirements

You can access your CME courses from various devices and platforms, on both PC and Mac desktops / laptops, as well as Android and iOS mobile devices. Our system requirements for these follow below.

Minimum System Requirements

  • The latest ChromeFirefoxSafariEdgeOperaor IE11 for desktop/laptop
  • A broadband connection with a minimum speed of 5Mbit or 800kbps
  • Please note that Flash Player is not required

PC Specific Requirements

  • Platform: Windows 8 or higher with the latest updates installed
  • RAM: 4GB or more
  • Video: Graphics output capability
  • Sound: Sound output capability

Mac Specific Requirements

  • Platform: Mac OS X 10.12 or higher with the latest updates installed
  • RAM: 4GB or more
  • Video: Graphics output capability
  • Sound: Sound output capability

Mobile Specific Requirements

  • iOS 11.0 and above
  • Android 5.0 and above

Mobile browsers: Safari or Chrome on iOS and Chrome on Android.

What Browser am I Using?

To find out more about your specific system, this site will tell you which browser and OS you’re currently using.

To watch courses, we recommend using Google Chrome. You can download Chrome for free here.

Contact:

NYSORA: Email info@nysora.com

PIM: www.pimed.com

 

3
Accelerated Learning with NYSORA simulators ™
Expires After: Does not Expire

 

 

NYSORA SIMULATORS™ are designed to facilitate ultrasound skill acquisition and retention. Each simulator includes relevant anatomy, allows for needle insertion and injection, and provides an in-depth, procedure-specific educational experience. NYSORA Ultrasound Simulators facilitate learning of anatomy, and they can also be used for testing knowledge acquisition and certification. One of the essential advantages of the SIMULATION is that the hand-eye coordination and needling technique can be practiced as many times as necessary. This is not possible or ethical in patients. The ultrasound and needle insertion skills can be learned before approaching patients, as well in practices in which there may not be enough patients for the training of all trainees.

NYSORA SIMULATORS™ feature remarkably accurate essential anatomy, small footprint, and replaceable inserts. The instruction for use and information can be found on NYSORA.com. The labeled structures are designed for self-practice or learning in a group workshop session. Different models optimize the development of specific knowledge and skills using both landmark and ultrasound-guided procedural techniques.

4
Covid-19 Prevention
Expires After: Does not Expire

5
Covid-19 Management
Expires After: Does not Expire

6
Local and Regional Anesthesia for the Eye
Expires After: Does not Expire

Indications: 

  • Sub-Tenon’s eye block: Majority of ophthalmic surgical procedures including cataract surgery, vitreoretinal surgery, trabeculectomy, adult strabismus surgery, panretinal photocoagulation, optic nerve sheath fenestration, long-term postoperative pain management, and therapeutic delivery of drugs. 
  • Retrobulbar and peribulbar eye blocks: Intraocular procedures (i.e., cataract surgery, vitrectomy, tube shunt placement, etc.), cyclodestructive procedures, strabismus surgery, and enucleation and evisceration. 

Goal: Local anesthetic spread in the sub-Tenon’s, retrobulbar, or peribulbar space, respectively, for sub-Tenon’s, retrobulbar, and peribulbar eye blocks. 

Needle: 21-25-gauge

Local anesthetic volume: 3-11 mL

7
Costoclavicular brachial plexus block
Expires After: Does not Expire

 

 

Indications: Same as with traditional infraclavicular block – anesthesia and analgesia for the upper extremity, elbow, forearm and hand surgeries, and analgesia for shoulder procedures.

Goal: Local anesthetic spread between the three cords of the brachial plexus

Transducer: Linear 

Needle: 22 gauge, 5 cm short bevel

Local anesthetic volume: 15-20 mL

8
Shoulder Block
Expires After: Does not Expire

 

 

The shoulder block is a selective block of the nerves innervating the shoulder: suprascapular and axillary nerves. It is an alternative analgesic technique to the interscalene or supraclavicular brachial plexus blocks that avoid the motor block of the arm and hand and the phrenic nerve (hemidiaphragmatic paresis).

Indications: Analgesia of the shoulder in patients with respiratory compromise (i.e.,  patients who cannot tolerate >20% reduction in the forced vital capacity (FVC).

Goal: Local anesthetic injection around the suprascapular and axillary nerves (or around the lateral and posterior cords of brachial plexus caudal to the clavicle).

Transducer: Linear

Needle: 5 cm (for supraclavicular approach); 5-8 cm (for suprascapular approach)

Local anesthetic volume: 5-10 mL per nerve

9
Nerve Blocks Above the Elbow
Expires After: Does not Expire

 

Indications: Anesthesia and analgesia for forearm, hand and wrist procedures

Goal: Injection of local anesthetic into the fascial planes enveloping the radial, median, and/or ulnar nerves.

Transducer: Linear

Needle: 25-gauge, short-bevel, insulated stimulating needle (optional)

Local anesthetic volume: 3–5 mL per nerve

10
Intravenous regional anesthesia for upper and lower extremity
Expires After: Does not Expire

Intravenous regional anesthesia (IVRA) or Bier block

Indications: Brief surgical procedures or manipulations (< 1-hour duration) of the upper or lower extremity

Goal: Injection of a local anesthetic solution into the venous system of an upper or lower extremity that has been exsanguinated by compression or gravity and that has been isolated from the central circulation using a tourniquet

IV catheter: 22-gauge

Local anesthetic volume: 30-50 mL for upper extremity (dependent on the size of the arm)

11
Erector Spinae Plane Block
Expires After: Does not Expire

 

 

Indications: Analgesia for rib fractures, back and chest wall surgeries.

Goal: Injection of local anesthetic in the plane deep to the erector spinae muscles and superficial to the transverse processes, to achieve a craniocaudal distribution along several vertebral levels.

Transducer: Linear or curved

Needle: 22 gauge, 5-10 cm short bevel

Local anesthetic volume: 20-30 mL

12
Rectus sheath block
Expires After: Does not Expire

 

 

 

Indications: Postoperative analgesia for midline abdominal incisions (e.g., umbilical hernia repair, periumbilical surgeries). 

Goal: Injection of the local anesthetic posterior to the rectus muscle but anterior to the posterior rectus sheath to block the anterior cutaneous branches of the intercostal nerves. 

Transducer: Linear

Needle: 50-100 mm, 22-gauge

Local anesthetic volume: 10-15 mL

13
The Hip Block
Expires After: Does not Expire

 

 

Indications: Analgesia after hip fractures or arthroplasty (especially through anterior approach).

Goal: Local anesthetic spread in the plane between the iliopsoas muscle and pubic ramus, and anterior capsule of the hip cranially to the acetabular rim. This injection anesthetizes most of the nociceptive fibers to the hip joint capsule which emanate from the lumbar plexus. In addition, this injection may prevent or decrease the postoperative spasm of the iliacus muscle, which is a common cause of postoperative pain after anterior hip arthroplasty.

Transducer: Curved (can use linear in smaller patients)

Needle: 80-100 mm, 22 gauge

Local anesthetic volume: 10-12 mL

14
IPACK Block
Expires After: Does not Expire

Infiltration of the local anesthetic between the popliteal artery and capsule of the knee (IPACK).

Indications: Analgesia after knee arthroplasty, cruciate ligament repair, and procedures involving the posterior aspect of the knee.

Goal: Local anesthetic infiltration over the posterior aspect of the femur underneath the popliteal artery. 

Transducer: Low-frequency curved or high-frequency linear transducer 

Needle: 80-100 mm, 20-22 gauge, short-bevel, insulated stimulating needle

Local anesthetic volume: 15-20 mL

15
Tibial nerve block at the level of the ankle
Expires After: Does not Expire

Indications: Specific anesthesia and analgesia in the respective territory of the tibial nerve

Goal: Local anesthetic spread surrounding the tibial nerve

Transducer: Linear

Needle: 25-gauge, 1 1/4″ needle

Local anesthetic volume: 5-8 mL

16
Deep peroneal nerve block at the level of the ankle
Expires After: Does not Expire

 

Indications: Specific anesthesia and analgesia in the respective territory of the deep peroneal nerve

Goal: Local anesthetic spread surrounding the deep peroneal nerve

Transducer: Linear

Needle: 25-gauge, 1 1/4″ needle

Local anesthetic volume: 3-5 mL

17
Superficial peroneal nerve block at the level of the ankle
Expires After: Does not Expire

 

Indications: Specific anesthesia and analgesia in the respective territory of the superficial peroneal nerve

Goal: Local anesthetic spread surrounding the superficial peroneal nerve

Transducer: Linear

Needle: 25-gauge, 1 1/4″ needle

Local anesthetic volume: 3-5 mL

18
Sural nerve block at the level of the ankle
Expires After: Does not Expire

 

Indications: Specific anesthesia and analgesia in the respective territory of the sural nerve

Goal: Local anesthetic spread surrounding the sural nerve

Transducer: Linear

Needle: 25-gauge, 1 1/4″ needle

Local anesthetic volume: 3-5 mL

19
Saphenous nerve block at the level of the ankle
Expires After: Does not Expire

 

Indications: Specific anesthesia and analgesia in the respective territory of the saphenous nerve

Goal: Local anesthetic spread surrounding the saphenous nerve

Transducer: Linear

Needle: 25-gauge, 1 1/4″ needle

Local anesthetic volume: 3-5 mL

20
Spinal anesthesia
Expires After: Does not Expire

Indications: Anesthesia for surgery below the umbilicus, procedures on the lower extremities, perineum, pelvic girdle, urological, gynecological, obstetric, and lower abdominal and perineal surgery

Goal: Local anesthetic spread in the subarachnoid space

Transducer: Curved

Needle: 25-gauge

Local anesthetic volume: 1.5–3.5 mL

 

21
Epidural anesthesia
Expires After: Does not Expire

Indications: Anesthesia for lower extremity, genitourinary, vascular, gynecologic, colorectal, and cardiothoracic surgery

Goal: Local anesthetic spread in the epidural space

Epidural needle: 17- or 18-gauge and 9 cm in length, with surface markings at 1 cm intervals

Epidural catheter: 19-gauge paired with 17-gauge needle, or 20-gauge paired with 18-gauge needle

Local anesthetic volume: 1-2 mL per segment to be blocked

22
Carpal Tunnel Release
Expires After: Does not Expire

 

NYSORA’s regional anesthesia and pain management protocols are standardized patient management pathways. These pathways can be reproduced or modified to developing individual institutions-specific pathways to standardize & improve quality and safety of perioperative management

23
Total Shoulder Arthroplasty
Expires After: Does not Expire

 

 

NYSORA’s anesthesia protocols for orthopedic surgery are only intended to provide guidance and assistance to anesthesia professionals in order to improve and maintain the quality and safety of anesthesia care.

Although the protocols are standardized, please keep in mind that some elements of patient care must be modified as seen fit, considering the distinct characteristics of the patient and the hospital resources available.

24
Total Knee Arthroplasty
Expires After: Does not Expire

 

NYSORA’s regional anesthesia and pain management protocols are standardized patient management pathways. These pathways can be reproduced or modified to developing individual institutions-specific pathways to standardize & improve quality and safety of perioperative management.

25
Total Hip Arthroplasty
Expires After: Does not Expire

 

 

NYSORA’s regional anesthesia and pain management protocols are standardized patient management pathways. These pathways can be reproduced or modified to developing individual institutions-specific pathways to standardize & improve quality and safety of perioperative management

26
Histology of peripheral nerves and light microscopy
Expires After: Does not Expire

Microscopic anatomy that emphasizes structure-function relations is important to the clinical practice of regional anesthesia. This course provides a basis for understanding the structure, classification, and organization of the peripheral nerves and insight into how the characteristics of the peripheral nerves relate to the clinical practice of regional anesthesia.

 

 

27
Local Anesthetics
Expires After: Does not Expire

28
Mechanisms and management of failed spinal anesthesia
Expires After: Does not Expire

It is not uncommon that a perfectly performed intrathecal injection of local anesthetic in an attempt to accomplish spinal anesthesia fails in a busy clinical practice. Despite the reliability of the technique, the possibility of failure can never be eliminated. Managing a patient with an ineffective or inadequate spinal anesthetic can be challenging, and prevention is better than cure.

Note

Possible mechanisms of failure include the inability to reach the subarachnoid space, errors in drug preparation or injection, the unsatisfactory spread of the injectate within the cerebrospinal fluid (CSF), ineffective drug action on neural tissue, and difficulties related to patient expectations and psychology rather than genuine block failure.