Plan A blocks in regional anaesthesia: a narrative review

Area of Science:

• Anesthesiology
• Medical Education
• Regional Anesthesia

Background:

• The Plan A blocks framework was established in 2019 to standardize regional anaesthesia training.
• It aims to build core competencies in versatile, high-value anaesthetic techniques for all anaesthetists.
• Evolving clinical practice and education necessitate a review of the framework's current understanding and implementation.

Purpose of the Study:

• To provide a pragmatic, clinically focused narrative review of the current understanding of Plan A blocks.
• To explore the implementation of the Plan A blocks framework in clinical practice.
• To identify and discuss future directions for the Plan A blocks initiative.

Main Methods:

• A focused literature search was conducted for articles relevant to Plan A blocks.
• Online resources, including society and institutional websites, were searched for pertinent evidence.
• A narrative review approach was employed to synthesize findings.

Main Results:

• Plan A blocks have influenced anaesthesia curricula and international consensus projects, identifying key blocks like interscalene brachial plexus, axillary brachial plexus, femoral, and sciatic nerve blocks.
• Challenges to implementation include resource limitations, lack of confidence, and variable training access.
• Emerging educational technologies show promise but face cost and fidelity limitations.

Conclusions:

• The Plan A blocks framework is an accepted, pragmatic, and scalable strategy for regional anaesthesia.
• Overcoming barriers to clinical practice change is crucial for its success.
• Widespread competence and integration into clinical pathways can enhance global patient access to regional anaesthesia.