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– Course Fee: $ 250.00 Course content includes 4 sessions: – Interscalene 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: Faculty: Admir Hadzic, MD, PhD Catherine Vandepitte, MD, PhD 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 Continuing Nursing Education 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: Catherine Vandepitte, MD, PhD: Planners & Managers: 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 PC Specific Requirements Mac Specific Requirements Mobile Specific Requirements 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 
– 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
– Supraclavicular Brachial Plexus Block
– Infraclavicular Brachial Plexus Block
– Costoclavicular Brachial Plexus Block
– 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
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
Consultant, Department of Anesthesiology,
Ziekenhuis Oost-Limburg
Genk, Belgium
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.
The maximum number of hours awarded for this Continuing Nursing Education activity is 5 contact hours.
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.
Receipt of grants/research supports from Pacira Pharmaceuticals
The PIM and NYSORA planners and managers have nothing to disclose
– Course Fee: $ 250.00 Course content includes 4 sessions: 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: Faculty: Admir Hadzic, MD, PhD Catherine Vandepitte, MD, PhD 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 Continuing Nursing Education 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: Catherine Vandepitte, MD, PhD: Planners & Managers: 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 PC Specific Requirements Mac Specific Requirements Mobile Specific Requirements 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 
– 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
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
Consultant, Department of Anesthesiology,
Ziekenhuis Oost-Limburg
Genk, Belgium
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.
The maximum number of hours awarded for this Continuing Nursing Education activity is 5 contact hours.
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
Receipt of grants/research supports from Pacira Pharmaceuticals
The PIM and NYSORA planners and managers have nothing to disclose
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.
Indications: 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
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
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
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
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)Intravenous regional anesthesia (IVRA) or Bier block
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
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
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
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
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
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
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
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
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
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 
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
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
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.
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.
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
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.
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. 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. Note