A Tryst with Ganga

Dear Bala Sir,

My Tryst with Regional Anaesthesia
I never expected to so madly fall in love with the subject when I took up anaesthesia. Kudos to my wonderful teachers, for they are the ones who showed me the beauty of this subject. Having gone through three years of gruelling yet thoroughly enjoyable post- graduate training I began to ask myself, ‘what next’?. It didn’t take me long to choose my path...regional anaesthesia. My better half asked me, “when all your seniors chase critical care, cardiac anaesthesia and neuroanesthesia, why regional?”. Endearing and challenging, that’s my answer.
I had grossly ignored the wonders of regional anaesthesia during my post graduate training. Plenty of neuraxial blocks and a few PNS guided nerve blocks, that was it. Even while getting updated with journal articles, I was blind to this sub specialty (isn’t it a super specialty?)
Having cleared my final DNB exam and stepping into the real world of practice, I gauged my extent of ignorance. My armamentarium was weak sans skills to deliver apt nerve blocks. Patients complaining of pain post operatively began to make me feel bad. I realised that’s it’s mandatory that I learn the art of nerve blocks. I began to read journals related to regional anaesthesia, and I was surprised to find the rapid pace at which this subject was growing. Ultrasound guided blocks began to fascinate me. Then came the nagging problem of failed blocks and grinning surgeons. Well, I won’t stop now.
How to gain better exposure to the subject? My mentor from my alma mater advised me to chase the European Diploma in Regional Anaesthesia examination. Thus I started my new quest. I read, read and read again. So where did I reach? Cleared the first part. What next? Practice. But how to learn and where to learn the ‘best practices’?
I learnt about the Inland Fellowship by AORA-Fujifilm Sonosite from a friend of mine. I was lucky to clear the entrance exam for the same (AORA 2018). When asked about my preferred centre for the week long training, I didn’t have to think, the Mecca for regional anaesthesia- Ganga Hospital, Coimbatore, Tamil Nadu was my first choice.
After discussing with my department (Department of Anaesthesia & Critical Care, VPS Lakeshore Hospital, Kochi, Kerala) and Dr. Balavenkat Sir (Course Coordinator), I chose the second week of October for the programme.

The Week at Ganga Hospital
It nearly took me half a day to get oriented with the working atmosphere at Ganga. I had a couple of good friends (Dr. Teena, Dr. Vinod Kumar SP, Dr. Tasneem and Dr. Tuhin) who made it easier to adjust (Thanks to Dr. Elayavendhan Sir for the lunch!). Still I was apprehensive since I didn’t know if I was allowed to ask questions/ doubts and disturb the extremely busy bees at Ganga. There are too many stalwarts at this place. So I stayed silent, but then I was surprised. The H.O.D (Dr. Sekhar Sir) himself started demonstrating blocks for me. In the days that followed, I started to feel pampered! Whenever a nerve block happened in my vicinity, the senior (special thanks to Dr. Gurumoorthy Sir and Dr.

Vipin Goel Sir) performing the block made it sure that I understood the sono-anatomy. It was a delight listening to Dr. Maheswari madam describing the evolution of regional anaesthesia at the hospital, how it grew from paraesthesia techniques to PNS to USG guided blocks.
I spent most of my time at the trauma theatre complex, and occasionally visited the plastic surgery theatres (whenever alerted by my friend about ‘blocks happening’). Bala sir did his best to make me feel comfortable, he kept asking me for a feed-back every day. The basics of USG was rekindled through discussions (thanks to Dr. Tuhin); I observed nerve blocks that ranged from the most basic ones to the most advanced ones (especially the QL blocks, PENG blocks and newer ones like supra axillary blocks). It was a real experience watching each consultant performing a block with his/ her own personal tweaks and listening to the rationales for the modifications.
So sound is the concept held by the practitioners here at Ganga that their techniques are perfect and many have already published their own block techniques. I will never forget the brain storming sessions I had with Dr. Kartik. He almost spent an hour every day teaching me concepts. Having listened to him I realised many of the mistakes that my techniques had.
The six days at Ganga was a refreshing experience; the hospital is a rare blend of workaholism, perfection and affection. Despite a never ending case list there is harmony and efficiency. The regularity of academic programme for trainees here in the midst of all the heavy work load is amazing.
Special thanks to Dr. Vinod Kumar R, Dr. Nikhil, Dr. Arti, Dr. Santhosh and the hard working nursing staffs and technicians at the trauma pre-op room.

The AORA Fujifilm Sonosite Inland Fellowship Programme: Suggestions
The fellowship programme is an excellent initiative from the organisers. It provided an excellent opportunity for a regional anaesthesia enthusiast like me to experience the work done by a centre of excellence like Ganga Hospital. The financial support/ sponsorship is a boon to the candidates who would otherwise be reluctant to go to distant places.
I hope every centre that is part of the programme has a structured one week schedule for the selected candidate/ observer. At Ganga hospital, I was fortunate enough to have Dr. Bala sir for making sure that I saw almost all the relevant regional blocks before the week was over.
I hope the programme will extend to a week long hands-on training in future. It would be too much to ask for, I know, since it would be technically difficult for a hospital to provide hands-on to a candidate who will be there just for a week. But I am sure that the idea of such a training initiative can be developed by AORA.
It would also have been nice if the seven selected candidates were given an option to enrol in the regional anaesthesia fellowship programmes that happen under the aegis of AORA, the Ganga Fellowship programme for example.
I sincerely hope that this programme happen every year so that more and more candidates can benefit, just like I did.

What lies ahead for me?

It’s a difficult question to answer. It’s a long road I realise. With the freshly rekindled concepts I will definitely improve my practise of anaesthesia, and try to free patients from pain as much as possible. In the long run, I wish to clear EDRA and FRCA. The second target that I have set is to gain expertise in the management of difficult airway.


Yours Truly, Dr. Nithin Jayan