contact: webmaster

The vast majority of regional anesthesia applied in the clinical setting is performed for orthopedic surgery. The BWH Orthopedic Service is one of the busiest in the operating room, running six operating rooms daily, and seven rooms twice a week, with a caseload in the vicinity of 5,000 per year. Of these, approximately 90% are done with regional anesthesia. Our junior residents have a mandatory orthopedic section rotation of three months. Hence, at all times, there will typically be a minimum of four to five CA-1 or CA-2 residents plus two to four senior residents and fellows on the service. The residents and fellows take night and weekend call in the general operating room pool with other residents to keep all of their anesthesia skills current. Techniques of regional anesthesia and their application to clinical practice a reemphasized. On occasion, residents assigned to orthopedics will be assigned outside the division. Once proficient and comfortable with the techniques, CA-3's and fellows will have the opportunity to supervise and teach junior residents. Staff anesthesiologists are active in teaching and are always available. Major textbooks in regional anesthesia are also available for reference. The section is very active in clinical research. Senior residents and fellows are expected either to participate in an ongoing clinical research project, or to start an original project with a staff anesthesiologist after receiving permission from the hospital Human Studies Committee when indicated. The trainee could also be involved with ongoing laboratory basic science projects. A senior resident or fellow will organize a weekly conference, preparing a weekly schedule for 1/2 hour presentations on subjects related to local anesthetics or regional anesthesia, to the application of regional anesthesia to certain disease processes, to orthopedics or any other subject of general interest. The fellow in charge of the conference may choose to discuss the subject or to assign the talk to a rotating junior resident or a staff anesthesiologist. A great number of patients on the orthopedic service suffer from rheumatoid arthritis or ankylosing spondylitis. Thus the management of the "difficult airway" is commonplace in our daily practice, encouraging the senior resident to become proficient in the use of the fiberoptic bronchoscope and in teaching the technique to junior residents. A solid knowledge of the anatomy of the airway, local anesthetics, topical anesthesia and some nerve block techniques are required for the successful use of the fiberoptic. Mercedes Concepcion, MD Director of Regional Anesthesia