steven rhondeau md co-founder, alliance for international

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