First published online in 2019, our editorial in Anaesthesia challenged the world of regional anesthesia by asserting the concept of ‘a few blocks for the many’ in opposition to ‘many blocks for the few [experts]’.
The rapid adoption of ultrasound in regional anesthesia led to an explosion in the number of new block techniques in which local anesthetic could be selectively deposited near nerves or in fascial planes. While these advances offered a wider variety of procedures to choose from, they arguably did not lead to greater patient access to regional anesthesia. Essentially, experts expanded their repertoire of blocks for their own patients.
This idea of having a ‘Plan A’ anesthetic (i.e. the consistent, reliable technique that you can count on in the middle of the night) as well as back-up plans (e.g. B, C, and D) is not foreign to anesthesiologists. The Plan A blocks educational framework suggests a core set of blocks (one per indication) for the general anesthesiologist who is not an expert in regional anesthesia and has been incorporated into the Royal College of Anaesthetists training curriculum.
There has been some controversy with the original list of Plan A blocks provided in our editorial since its publication, with many experts in regional anesthesia arguing about the individual blocks mentioned. However, the list itself is merely a suggestion and can be adapted to the needs of the training program or practice.
In a new Core Topics article dedicated to Plan A blocks published in Anaesthesia, we have updated the list of suggested blocks in the Plan A/B/C/D table, provide the evidence supporting the use of the Plan A blocks educational framework, and suggest future steps to implementing the broader use of regional anesthesia to improve patient care.