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Patient‐centred care in regional anaesthesia – a reply

We wish to thank Dr Selak for her thoughtful and wellwritten letter [1] in response to our editorial [2]. We are grateful to her for mentioning the ‘robust discussion’ on Twitter that followed its publication, because prior Twitter conversations served as the inspiration for the editorial. Social media, and specifically Twitter, has connected the community of anaesthetists like no other communication tool has before [3], and we believe these connections serve to inspire innovations in clinical practice and research, as well as prevent feelings of isolation that can happen in anaesthesia, leading to burnout. We will be the first to admit that our editorial is incomplete as written; it should serve as the start of a conversation and not the conclusion. We all agree that it is time to revisit basic regional anaesthesia training for all anaesthetists. The three of us were not unanimous in our selection of ‘Plan A’ blocks in the table of suggested highvalue blocks. However, we did agree that the blocks included in this column represent transferable skills that allow the general anaesthetist to build a strong foundation in regional anaesthesia. A different academic institution may prefer to substitute a Plan B block for a Plan A block based on the instructors’ training and regional anaesthesia practice (e.g. infraclavicular instead of axillary; fascia iliaca instead of femoral). We consider such substitution completely acceptable as we believe the skills required to perform these pairings to be transferable. We could not agree more with this statement from Dr Selak: “The holistic anaesthetist cares about the emotional wellbeing of the patient, as well as technical aspects of care.” Most research studies involving regional anaesthesia training tend to focus on technical skills alone, as these are easiest to assess [4]. In truth, the non-technical skills are as, if not more, important in regional anaesthesia practice. As Dr Selak correctly points out, patient-centred care requires involvement of the patient. An article by Heidegger et al. summarised the factors that most influence patient satisfaction with anaesthesia, and the areas rated highest were information and kindness/reassurance [5]. This means that our training programmes should consider teaching future anaesthetists how to provide patients with appropriate education in order to facilitate shared decisionmaking [6], and our regional anaesthesia curricula should include training and assessment in technical and nontechnical skills, as exemplified by the Direct Observation of Procedural Skills tool [7]. Moreover, we believe that any future consensus on clinical or educational practices in this setting must involve patients. We also believe that future research in regional anaesthesia, as with all disciplines in the specialty, must focus on patient-centred outcomemeasures rather than statistically sound but clinically uncertain metrics, such as time to performance of blocks [8]. Anaesthetists may not always agree on the best block for a given indication, or even how to perform the block, but we all care about improving patient outcomes and the experience of patients having surgery, which is why we are so passionate about regional anaesthesia. As a connected community, we can work together to redesign training for anaesthetists and make regional anaesthesia available to all patients, regardless of setting.