September 2016

  • a)  Which specific nerves must be blocked to achieve effective local anaesthesia for shoulder surgery? (6
    marks)
  • b)  What are the possible neurological complications of an interscalene block? (6 marks)
  • c)  Outline the measures available to reduce all types of neurological damage during shoulder surgery. (8
    marks)
Shoulder block Pass rate 48.3% This question also correlated well with overall performance. The anatomy was not well known to a lot of the candidates so quite a few marks were lost here. This is a recurring theme in the Final exam - remember that anatomy relevant to clinical practice is likely to be included. Failure to read the question again caused some candidates to lose marks. Part (b) asked specifically for possible neurological complications of an interscalene block and quite a few candidates wrote about non- neurological complications.
September 2014

  • a)  List five nerves that can be blocked at ankle level for foot surgery? (5 marks)
  • b)  For each of these nerves, describe the sensory distribution within the foot. (5 marks)
  • c)  Give the anatomical landmarks for an ankle block which aid correct placement of local anaesthesia for each
    nerve. (5 marks)
  • d)  What are the advantages and disadvantages of an ankle block? (5 marks)
  • You may use a table for this answer if you wish.
Common clinical subjects tend to score well in the SAQ paper and discriminate between strong and weak candidates as was the case for this question. Weak candidates had poor anatomical knowledge or failed to list the advantages of this specific block, giving instead the features common to any local anaesthetic technique. Poor candidates tended to describe features of blocks at the popliteal level, perhaps due to failing to read the question thoroughly as ankle level was highlighted. The importance of candidates retaining knowledge of the basic sciences has been highlighted before.
September 2013

a) What are the complications of continuous epidural analgesia (CEA) in the ward setting? (40%)

b) How should patients be monitored throughout the period of CEA? (25%)

c) Outline the safety features that relate to equipment used for CEA. (35%)
70.4% Pass rate.

The question was based on the Best Practice in the management of epidural analgesia in the hospital setting. (November 2010), published by the Faculty of Pain Medicine of the Royal College of Anaesthetists. Section a) was divided into: complications of local anaesthetic, complications of opioids, human and organization factors (inadequate analgesia; drug administration errors; post dural puncture headache) and siting issues (infection). The safety features relating to equipment included both the pump and giving set. Some candidates focused on the giving set only. The pump should be configured specifically for epidural infusion and should be standardised as per MRHA, have alarms and be tamperproof.
March 2013

a) Which specific nerves must be blocked to achieve effective local anaesthesia for shoulder surgery? (30%)

b) What are the possible neurological complications of an interscalene block? (30%)

c) Outline the measures available to reduce all types of neurological damage during shoulder surgery? (40%)
69.2% pass rate.
This question was answered well. If an open question is asked on the possible neurological complications of a block then this will include damage to both the peripheral and central nervous system. Some candidates focused on the peripheral nerves only. The answer to part c) required an account of both anaesthetic and surgical factors that would reduce neurological damage. This included “avoiding interscalene block” in the first place. The question was a very good discriminator.
September 2012

a) Describe the innervation of the anterior abdominal wall. (20%)

b) In which types of surgery would a transversus abdominus plane (TAP) block be used and what are
the potential benefits? (25%)

c) Outline how you would perform a TAP block. (40%)

d) What are the specific complications of a TAP block? (15%)
Question 1: Anatomy (innervation of abdominal wall)/TAP block.

67.4% pass rate.

The question was relevant and topical. Many candidates had poor knowledge of the innervation of the anterior abdominal wall. Overall was answered well.
September 2012

a) List the implications for the patient of an inadvertent wrong-sided peripheral nerve block. (25%)

b) Summarise the recommendations of the “Stop Before You Block’’ campaign and list factors that
have been identified as contributing to the performance of a wrong-sided block. (45%)

c) Define the term “never event” as described by the National Patient Safety Agency and list three
never events of relevance to anaesthetic or intensive care practice. (30%)
Question 6: Wrong side block/”Never events”.

40.5% pass rate.

It is disappointing that many candidates displayed a relative unfamiliarity with the Stop Before you Block Campaign. This is an important national patient safety initiative that was introduced recently to reduce the incidence of inadvertent wrong-sided nerve blocks. Many examinees left some sections unanswered. Some candidates could not adequately define the term “never event” despite its topicality.
September 2010

a) Describe the type and course of primary pain afferents from the cornea to the brain. (20%)

b) List the techniques which can provide local anaesthesia of the cornea. (15%)

c) Which nerves need to be blocked to achieve complete akinesia of the globe? (15%)

d) What are the complications (25%) of sharp needle orbital blocks and how can they be minimised? (15%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
September 2010

What are the
a) cardiovascular (25%),
b) respiratory (20%),
c) gastrointestinal (20%) and
d) haematological (25%) potential benefits of local anaesthetic neuraxial blockade?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2009

An adult patient is scheduled for shoulder surgery under an interscalene brachial plexus block.

a) Outline the possible unwanted neurological sequelae that may occur with interscalene block and their associated symptoms & signs? (60%)

b) What steps may be taken while performing the block to reduce the incidence of these problems? (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2008

a) Describe the surface anatomical landmarks for (i) the anterior (Beck’s) and (ii) one posterior approach to sciatic nerve block. (50%)

b) What practical advantages and disadvantages would you consider when choosing between these two approaches in an individual patient? (20%)

c) List the complications that may result from this block. (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2008

a) Describe the anatomy of the thoracic paravertebral space. (35%)

b) What are the indications for paravertebral nerve blockade? (25%)

c) List the complications of a paravertebral nerve block. (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2007

a) Describe the anatomy of an intercostal nerve. (25%)

b) How does this influence your technique of intercostal nerve blockade for a fractured rib? (35%)

c) List the complications that may arise and explain the anatomical reasons for these
complications. (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2006

Regarding caudal anaesthesia in children:
(a) What anatomical features are important to consider when performing the block (caudal) safely? (30%)
(b) What are the contraindications? (20%)
(c) What are the problems and complications?(20%)
(d) What constraints limit the effectiveness of the block and how can they be overcome? (20%)

Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
May 2005

Which patients are at increased risk of infection related to an epidural catheter? (30%)
What symptoms and signs suggest the development of an epidural abscess? (30%)
What investigations would be definitive in initiating further management? (20%)
What should this be? (20%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
October 2004

What are the indications for a popliteal fossa block? (10%)
List the nerves that are affected and describe their cutaneous innervation. (35%)
What responses would you get on stimulating these nerves? (25%)
Briefly describe one technique for performing this block. (30%)
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question
April 2002

Draw a diagram of the lumbar plexus. Outline the anatomical basis of a ‘3 in 1’ block. Explain why the block may fail to provide reliable analgesia for hip surgery?
Question11 Critical care/management of airway problem/tracheostomy

76.6% pass rate

In the main was a well-answered question