S1:E9 "The 2023 RA-UK Roundup! (Highlights from the RA-UK Regional Anesthesia meeting)"

We're feeling totes emosh about being back for this episode. I want to know if you are a okay for another stimulating discussion. I'm Amit Pawa. Whether you're listening to this in a hot tub or in a cozy fort made of blankets, we hope this episode makes you feel sparkly. I'm Jeff Gadsden, and this is Block it like it's hot. 

Hey, Jeff. How are you, man? Hey, Amit. I'm doing well, man. How are you? 

Well, you know, to be honest, Jeff, I'm feeling totes emosh. Are you familiar with that phrase? No. No. I I think I could figure it out, though. 

Totally emotional. Right? Why? Why so, buddy? Come on, man. 

I miss you. The last time we met was at REUK twenty three, and that was back in, May, the Star Wars theme. That was put on by Alan McFarlane and RUK in Newcastle. Yeah. And and we haven't recorded a podcast since then. 

I miss you, man. It was, you know, it was so good to be able to hang out with you in person for a decent amount of time since the first time we started our podcast, and now I'm a bit sad that that's all over. Yeah. I know, man. I hear you. 

It was it was so good to see you. It it was it was weird, though. Right? Because I felt like we had been meeting regularly for a podcast, but, we actually hadn't seen each other since, like, a year before in June. That's right. 

Yeah. It's it's really I think it's really neat. The beauty of this technology is that now we're, like, we're in the same room and catching up again, and it feels like we could be in a pub or in a bar. And in fact, I'm gonna pour myself a drink. Listen. 

I'm gonna join you. Let me see if I can get my, myself a drink right here. Obviously, it's a coffee because of the time that we're recording this. Speak for yourself. So what have been up to? 

Well, listen. I'd like to say not much has changed, Jeff, but, unfortunately, a lot has changed. Oh, that sounds ominous. It it it is ominous. First up, guess what? 

I've lost my recording studio. Well, I I can tell that you're not in the same space. It's a bit of a different background here. Yeah. So so my youngest daughter, Sienna, had a very helpful cabin bed. 

And the first, eight of our podcasts were all recorded with me underneath the bed with a duvet on top to get beautiful soundproofing. But now Sienna's not a, you know, not a young girl anymore. She's she's going into a young woman. She wanted a space. She didn't want a cabin bed, so she's got a regular bed, and I've lost my recording studio. 

So So you say when you say cabin bed, is that bunk bed? Is that what we we call a bunk bed? So so a bunk bed, by definition, has got two beds. Right? So a cabin bed has got a bed up on high, and then underneath it, she had a desk. 

A desk. Yes. Yes. Which was perfect. So I could kind of hide under the bed. 

Was I it was like I was on a camping trip when I was, you know, drifting away into our, you know, recording, Zen mode. I was just gonna say, listeners at home, it's it's a pity you can't you you can't see this, or couldn't have seen this in all of recordings that we had done. Like, me I'm looking at Amit on while we're FaceTiming doing this, and it's like he's making a little fort as a child with blankets and pillows and that sort of thing. It was very cute. You know, Jeff, that's exactly what it felt like. 

So every time I did it, you know, so the kids would be like and my older daughter was saying, it was like, are you going for your alone time with Jeff now? And I said I said, yep. We're going camping. That's where we go. That's where we're end the podcast, alone time with Jeff and I. 

Well, now the disadvantage with me now being in this new location is that I'm a little bit more exposed. So listeners, forgive me if you hear some drilling because my next door neighbor has decided to do some building work. You may hear the doorbell for, for deliveries, and then also you may hear the window cleaner in the background. So I'm hoping that there's not gonna be too much disruption, but it may be a slightly different audio experience. Well, sounds good so far. 

Well, listen. You know, I'll you what else has happened. So you may or may not remember, we've had some great engagement from, you know, from folks via Twitter or x as it is now from all over the world. I can't get used to that. That's just weird. 

Well, I you know what I've done? On my iPhone, there was a somebody gave a very, helpful tip to change the icon or to create a shortcut for x and change the icon back to Twitter. So I've done that because I just can't deal with that. You like the black and white x. Yeah. 

I like the blend. Good for you. So I've done that. But anyway, you you'll remember that we've engaged with people who live the world from Twitter x. And one of them was a nieces called Mick Kerr. 

Oh, yeah. Made some great videos, YouTube videos, and and he's been using some great software. He's taken it next level audio, video, entertainment. So rewinding videos back and zooming and all the rest of it. Anyway, he was in The UK, and I got to meet him in person. 

So that was really cool. Oh, so great. So he he came and met me right by work, and we found out that it's not just regional anesthesia that we have in common. Okay. Do tell. 

We both share a love of Please don't say Disney. Idris Elba. You and half the planet. Yeah. I mean, come on. 

The guy is too cool for school. Right. But we were both we were both watching. There's a there was a series on Apple TV called Hijack, which kinda got slated in the reviews, but I was totally feeling it. So we talked about that, and then we talked about Luther. 

There's another you know, he plays this this this bad British I've seen some Luther. Yep. Yeah. So there's there's a new film out on Luther. So we were talking about that. 

So that was it was it was quite fun to kind of meet him and find that we had more in common than just a love for regional and Caesar. So so, Mick, thank you for coming to check, to come and find me. It was great to meet you. That's great. There's some other cool stuff that's happened. 

I mean, I've got loads of stuff to catch up on. This could be the whole episode. What Hamid did since the last podcast. So I met up with two very cool guys, John Rubin and Rohan Jatwani, and and those guys are based at Weill Cornell in New York City. And I met John at a conference recently, and he said, we wanna hook up with you guys, because we've got some great ideas with VR technology. 

And do you know what? I'm meeting them later on today. They've got some great ideas with VR headsets going into a virtual world like an anatomical sandbox, and people from all over the world interacting with three d anatomical models. So watch this space. There's gonna be some exciting stuff. 

It's just like your it's just like your cadaver thing again where it's, like, walking around the room and Yeah. Sitting down on my couch. It is, but it's but it's next level. I mean Okay. Before before I got into the the this, this podcast with you, I was just having a play. 

So I managed to bring the skeleton from the other side of the room right in front of my face, and then I put my head inside the skull. I mean, it's nuts. But you can actually teach nerve blocks using this technology. Very cool. So anyway, I'm looking forward to seeing what we're gonna do with that. 

So that's that's one thing that's exciting. And then two more things to talk about. Number one, I bought a new hot tub. That's that's amazing. That's that why didn't you lead with that? 

Because I didn't want to show off, man, but it's kind of been the highlight of my year so far. When you say new hot tub, does that imply there was an old hot tub and you just sort of upgraded? Or Well, yeah. That we we we had one of these permanent inflatable hot tubs. It was great, and it lasted us for a few years, but it finally packed in. 

And we were about to well, I was about to buy a new one, and and my wife said, Amit, don't be crazy. Don't waste money. Sensible. If you if you love it this much and you and you demonstrated a commitment to to the cause, why don't you invest the money in something a bit more robust? So we bought a real hot tub and and, yeah, many, many hours of fun by myself, and and occasionally the family joined me, but it's great. 

I I I love that. So you're a hot tub guy. Okay. Alright. Good to know. 

Yeah. Yeah. And listen, I'm totally I'm totally down with that. Now the last thing When you say hold on. You can't move on from that just so quickly. 

When you say hours, I mean, are you listening to music, reading a book? Like, cut it. You know, candlelit? Are you So so what? Are you doing work? 

You guys is your laptop in there with you? No. No. So initially, the the the beauty about this hot tub was it came around sort of per COVID. It was a it was a way of us removing ourselves from any digital communication, and my wife and I actually engaged in conversation, and we weren't allowed any, any extra media in there. 

Oh, that's great. That was good, and it actually became something we do at the end instead of watching TV. But now and then my kids were not down with it, but actually now, they quite enjoy it as well. And it's also it's bit of a hobby for me, the upkeep. I get to play with chemicals. 

This is this is a very boring hot tub podcast. We're not gonna talk anymore about this, but listen. I get to play with chemistry, chemicals, and I get relaxation. It's a win win. Win win win. 

Yeah. And the last thing is you may or may not remember, I told you I was in New York earlier this year. Yeah. I remember that. Guess what, buddy? 

Oh, god. There there's a drilling, guys. If you can hear that drilling, that is the next door neighbor guys drilling next door. Hopefully, we'll be able to drown some of that noise out. But, anyway, you may not remember earlier in the year, went to New York. 

Guess what, man? I'm headed back there again. Really? Yeah. Wow. 

You that's amazing. When are you coming? So we're we're heading sort of August. You know, the the family and I love New York so much. So we're gonna head back there, and this time, hopefully aim to do things that we didn't get done the first time we did, you know, the Statue Of Liberty before, but this time we're gonna hope to do some some different things. 

So so that's that's me summed up in about ten minutes. That's everything I've been up to. How about you, man? What you've been up to? Yeah. 

A lot of the same lot of the same stuff. Nothing nothing too too crazy. We were, up in Canada, last week visiting family. So got to see my parents and hang out with my brother Dave and his family. So, yeah, kids got to hang out with their cousins and and had a great time. 

Spending time with family, man. That's that that's what it's all about. Right? So that was that was cool. And and then, you know, you've been I know you've been carrying on with all your other work, your other projects, but have, you know, have you had a chance to kind of wind down and chill after all the activity over the last few months? 

Yeah. Yeah. I spent a lot of time, home with the family, hanging out with Cory and the kids, read a bunch of books. We got away for Reef's birthday to Busch Gardens, which is an amusement park, so lots of high speed roller coaster thrills there. But, yeah, it's been a lot of lot of quiet family time. 

We got our new fellows, so our our it's always a sad always a a bittersweet time in this time of year because we we lose our fellows and, who we spent, you know, a year with, and they've all moved on to to carry the torch, carry the duke wrap torch somewhere else. And, and then, you know, coming back from vacation this this past week, I've gotten to meet some of the new ones. So It must be amazing, actually. I guess if you think back over the years about the amount number of people you've trained in regional anesthesia, it's pretty phenomenal. Right? 

And they and you set these people as you say, you've set them on their journey to move wherever they're gonna go across the country, across the world. It must be a, you know, phenomenal feeling to go to do that. It I mean, it's it's the most rewarding part of a job, I think, is to is to be able to, yeah, teach and mentor and be a sponsor and and that sort of thing, which we'll talk more about as we get into the the Bruce Scott lecture. Absolutely. Absolutely. 

Dude, you know, I was just gonna say, have you noticed I I I I tweeted recently. The podcast has had over 17,000 downloads. Can you believe that? I mean, it's it's amazing. Thank thank you so much to all of you who are listening to this, listening to us talking about hot tubs and, other other stuff. 

We appreciate it. No. Absolutely. We we're really we're really grateful. It's yeah. 

I'm I'm trying to imagine what it must be like for people all over the world to be listening to these bizarre conversations we have. But, you know, we also talk about some some educational stuff. Right? Yeah. We get it in there somehow. 

So speaking of which, what are we, what's our topic today? Well, you know, we've already mentioned it already. So I what what do you think about us talking about the highlights of the REUK meeting twenty twenty three that was held in in in Newcastle in May for this episode? What do you think about that? Sounds good. 

Let's get into it. Okay, man. So listen. I was thinking about you know, it was such a great conference that, you know, the organizers of that conference put on lots of diverse content, and there were lots of different speakers. So I thought we'd talk through some of the sessions. 

One of the bits that I really, enjoyed about about REK was the fact they've decided to have these plan a blocks or basic nerve blocks live scanning demos. That's where you'd have a couple of regionalized, these are demonstrators getting up on stage with a model and had camera guys showing their hands and then a live feed from the ultrasound image, and you got a chance to pick up some tips and tricks and see live scanning and and and see how people troubleshoot it. So, you know, that was amazing. So you were up on stage. And who who, you know, who were you scanning with, and what were you what were you demonstrating? 

I was with Athma Fotengel, and, we were and I agree. This is such a good format. It's it's really, really cool to be sitting back and watching the multiple feeds. So you've got the camera showing where the hands, the probe, where the needle would go, and then the of course, the ultrasound image, you know, huge up on the screen there. And and just to watch someone go through all the steps and then go back and say, well, what if you got this, and what if you got that, in real time was was amazing. 

So so, yeah, we did the canal, or femoral triangle block and the popliteal sciatic. Yeah. It was really it's a really cool format. And I loved watching everyone else do it and picking up on their sort of tips and tricks. Well, I think that the thing that's amazing is no matter how experienced you think you are, when you're watching one of your colleagues who does things, like you every day, you'll always pick up something new. 

And and, yeah, every time I think I've I've I've mastered something, I'll watch somebody else, do a nerve block, and I'll pick up some other tips and tricks, and that was great. Isn't that amazing? I I I I feel the same way. Like, feel when I go to a when I teach a workshop that I've taught literally hundreds of times before, I will still pick something up many times from the participants. Yeah. 

Someone will come in who I'm I'm meant to be teaching, and they're like, well, you know, have you thought about doing it this way? Or what if what if you had this sort of situation pop up? And I'm like, well, you know what? That's that's a good question, or it's a really good point. You know, I I had exactly the same experience at one of the workshops I was teaching. 

I was teaching one of the abdominal wall blocks, and somebody said, actually, you know what? I'd I'd like to do this. I was like, wow. Thank you so much. So, you know, that that's great. 

Yeah. Always learning. The other thing that was they're always learning. And the other thing that was interesting and that kind of, that put me a little bit under pressure, they like they we had a couple of lineups, right, asked the experts where they lined us up on stage, and there were some questions that had been submitted, some by the audience and some by maybe some other faculty members. We had no prep, and they just asked us those questions and put us a timer, up, and we had to get our answer out within a fixed period of time. 

Do you remember that? That was that was fun. Right? Oh, it was fun. Kareem Halmagdadley did an amazing job as as the moderator there because he was just, you know, kept it going. 

Alright, Jeff. You've got sixty seconds. Answer this. And buzzer goes, next question. And, like, try to try to I felt like it on a game show or something, but, you know, it's good. 

It's that's exactly what it feels like. Now I the other thing that was that was interesting is they would often ask the same question to panel members and go along the line. You think, gosh. Now it's gonna come to me. What do I say that's not the same as that person? 

So I I I I Yeah. How do I sound smart after this after Asthma just said that? Yeah. So I I found that, I found that quite quite good fun. Now there was another session that was really interesting. 

There was a whole, a whole talk on communication skills, and that was delivered by, doctor Barbara Braebart. And she was talking about elements of nonverbal communication and the way you shape and frame conversations, picking up on things like the nocebo effect. There's some work that was done by, a couple of people, Alan Sena and Elvira Lang. Do you remember that talk? And do remember do you know what I'm talking about? 

Oh, yeah. Absolutely. No. That was a that was a really engaging present. She's a really good speaker, and, and I I really enjoyed that. 

It was neat to hear her thoughts on how you present things like, I'm gonna stick a needle in your back now. And and rather than use negative language, just use straight language and allow and I the thing I took away from that was allow the patient to to take part in the interpretation of what you're about to say. So instead of saying, because I'm I'm guilty of this too, I'll say, like, are you feeling pain right now? Are you feeling are you feeling my needle Mhmm. Hurting you? 

I don't actually say that word. But rather than say that, say, what are you feeling? Or or just neutral language. I'm just placing the cannula in the back of your hand. Yeah. 

As opposed to one of the best lines I heard, a nieces I worked with before, they're just about to place a cannula, intravenous cannula, and they went, okay. Here goes. Ouchie. Ouchie. Ouchie. 

Right. Right. Right. Right. I mean, and the other thing is we don't realize a lot of the things we say as a matter of routine. 

So I was watching what was happening in theater in the in the anesthetic room the other day, we had a patient come in. I had a trainee that was putting a cannula in. I had my anesthetic nurse who's putting some monitoring on, and I was, was doing the sign in. And the anesthetic nurse said, we are attacking you from all sides now. And, you know, whilst that phrase, that statement kind of it it highlights what you're saying. 

Actually, why would we use such language just before you're putting somebody off sleep? So it definitely made me think about what I say and the way I say it. And instead of saying when you inject the profile, okay, this is gonna feel really cold or this is gonna sting, I've had other people say things like it's like, Tanya Selak from from Australia. She says, oh, it's gonna feel a bit sparkly up your arm. So using different language. 

So yes. Sparkly. Oh my god. I love that. I, I'll often turn it into a, sort of bartending experience and say, like, you're gonna feel we're we're giving you a cocktail. 

This today's cocktail is a spicy margarita. You're gonna feel, you know, a little jalapeno going up your arm, but, I like spark sparkly. That's good. I've tried that, though. But but then every now and then you have somebody says, oh, actually, I don't drink or or I've given up alcohol for lent or something. 

And and so then I have to go to quickly, retract or adapt it. So yeah. Yeah. I know the other thing I've tried, I picked up this tip from, from a couple of, folks, Heehan van Geffen and, from Kijin Chin, just creating a mood or a discussion and, you know, imagine getting somebody to imagine they're on a beach, and, you know, you set the scene, you get them to imagine certain things. And then as you're injecting the profile, you say, hey. 

Can you feel the sun on the back of your arm? And, actually, sometimes people totally go with it and they fly and they go, oh, yes. It feels warm on my arm and I can feel it on my face. And then boom, GA. So, yeah, lots lots of interesting things to think about there. 

Yeah. That was a cool session. And and then there was now there was another session. So so James Bonas wasn't able to be with us physically there, but he actually dialed in and did a virtual talk on artificial intelligence. And for those of you who don't know, James has actually published, I think, probably the most papers on on artificial intelligence in regional anesthesia talking about how we can use it in practice. 

I was actually, and I know James, but I was still fascinated listening to how these systems work and how we might be able to integrate them into our future analytic practice. And we've talked about this before. Right? Yeah. It was fascinating to hear him talk about the process of how they get the computer to be smart, about recognizing the anatomic elements and that sort of thing. 

That was that was really cool. I mean, he went deep into machine learning and what all that that helped me way above my head, but very, very cool. And I think that that it's just a I mean, we talked about this before. It's a it's going to be an incredible tool for teaching. Yeah. 

And I think we're we're kind of highlighting some issues in The UK certainly where we're maybe not able to deliver the amount of training across the board to all of our, our trainees in all aspects of regional anesthesia or certainly things that we think are core. And that's where having the ability to utilize some of these these new tools, may be useful, whether it be a needle trainer so you can scan a normal friend or a colleague and then pretend to stick a needle into them, or whether it's just giving you some guidance to help revise the structures. I think AI is the future Yeah. Without a doubt. Yeah. 

And it's what's gonna be really interesting, getting just building on that point is seeing how technologies like this are gonna allow us to expand regional anesthesia to more resource poor areas. So parts of the world that can't get to a workshop. Well, maybe now you don't have to. If the structures are there on the screen labeled, maybe you don't have to have high quality in person workshop type instruction. Yeah. 

Yeah. Yeah. For sure. For sure. And and sort of talking about, remote parts of the world, there was another session that was a, a small session. 

It was it was given on the first morning or the so rather the second morning. This is an equality and diversity session. And one thing I can say as being a previous, board member and president of our of our UK is we've looked at how the dynamic and the shape and format of the board has changed over time. And we made a really, invested and, made a keen effort to make sure we are as inclusive as we can be. But what was fascinating about this session was to hear people talking about, their journeys and their experience through medicine, through anesthesia, and the difficulties they may have encountered now. 

I feel very fortunate in that I haven't directly, I suspect, experienced much of that. Many many hinders, hindrances to my career. I've been very fortunate. That being said, you know, there have been things that we've come that I've come across in my career that maybe weren't ideal or could have been easier or could have been better. But, actually, when you hear other people and the difficulties they encounter, and how, you know, they've got to have decent role models to look for, people that look like them, people who speak like them, It it it for me, was fascinating. 

And one of the things they were talking about is a delivery of regional anesthesia and maybe some research resource poor parts of the world. So that was, that was an emotional session. Yeah. I found it, really, really important. And it's something we need to be aware of. 

Right? We need to make sure that we represent all of our community, everyone that's involved, and that everyone's got a role model or someone to look at and say, yeah. That person I can relate to. I wanna be like them. It's so important. 

Right? I think to have to have a a role model that makes you feel, okay. I can if they can do it, I can do it too. Completely. Completely. 

So, yeah, I I'm sure there's gonna be lots more work. I know, Alan McFarlane, as president of REK, and the whole board are looking at ways they can improve, diversity, equality, representation across the board. And that, you know, there's there's lots we can do. Now there was another really cool session. So somebody who I met for the first time on Twitter, she's an allergist called, Sophie Faruk. 

Now Sophie did a whole, session on local anesthetic allergy, and what I loved about her session was how she presented it like being a detective and how trying to work out what the, what the culprit is. You know, local anesthetic allergy is rare. Right? Have you ever come across a case of a patient that was allergic to local anesthetic? Well, not no. 

I mean, I I I should say not really. I mean, I we've had patients say, oh, I had a a reaction to a local anesthetic injection in a dentist, but, you know, a lot of the a lot of those are just, you know, reactions to the epinephrine or the adrenaline in the in the solution and racing heart rate and all that kind of stuff. I have had one or two patients in my career say, no. No. No. 

I I do have an allergy to to lidocaine or something like that. And it it was a of a head scratcher. And I I agree. Her her session was really cool. It was neat to have and kudos to to the organizing committee for thinking to put an an allergist on the Absolutely. 

Schedule on to to hear from because it was neat to hear her perspective about, you know, what do you do when you get a suspected case and how do you do the intradermal testing and all that kind of stuff. That was that was neat. No. I haven't had a a local anesthetic case of anaphylaxis in my career. I never I never seen one or or nor have I heard of one. 

Well, you know, I have. I had a patient obviously, I can't share the details. I don't wanna make them identifiable, but I had a patient who was due to have, sort of a semi urgent orthopedic procedure who presented me with some blood test, some RAST tests that were done in another country that showed that she had a positive reaction. I can't remember what RAAS stands for. Radioallergen absorbent something something test. 

It's one of those allergy tests, a blood test. Do you remember what it stands for? That sounds right. Yeah. Radioabsorbent allergen sensitivity test. 

Something like that. There's absorbent absorbent is in there. Right? That sounds right. But anyway, this individual had had these blood tests that showed that they were allergic to a number of amide local anesthetics. 

And, you know, they never had those ant anesthetics administered, but they're just a blood test. I've never no idea why they were done. So I thought, what do I do here? I tried I got some advice. In fact, I contacted Sophie, and, you know, she said it would be really risky if I just carried on and did the block. 

There's a whole way I could exclude them, but I didn't have the the way of doing that myself. You know? I've been and I had no time to get referral to an allergist. So guess what? I did this procedure without any local anesthetic, and the patient was okay. 

What? Really? Yeah. I get I had to use I had to get I had to use a whole host of drugs, but, actually, they were okay. So, you know, sometimes don't tell anybody, but, actually, sometimes you can manage without local anesthetic. 

But, yeah, that will be the only time you hear me say that. Shocker. Okay. Know You what's interesting? As a as a side note to this allergy thing is, have you guys got this alpha gal allergy in The UK? 

Do you know what I'm talking about? I'm sorry. Say that again? Alpha gal. It sounds it sounds like a Cartoon character. 

A comic book hero. Yeah. Yeah. Alpha gal. No. 

It's, it's it it stands for alpha galactose something or other. It's it's weird. It is a allergic syndrome that you get by being bitten by a tick, the lone star tick. That's common in the Eastern And Southeastern Part of The US. And what it does is it provokes an allergy to red meat, to mammalian meat. 

And so these patients get bitten by a tick at some point, and then at some point they go eat a hot dog or a burger or a steak and have an anaphylactic reaction. Oh my goodness. Yeah. And the problem is there's an I mean, that's that's enough of a buzzkill. Right? 

Like, you no longer can can can have No barbecue. Right. No barbecue, which is a which is a big big deal where I live. But there are a ton of pharmaceuticals that have animal products in it, like gelatin and the capsules or or even some of the excipients in in the Right. The injectables and that sort of thing. 

So there's a whole list of things you cannot give these patients. It's interesting. It has come up more and more frequently. Like, what do you do for your alpha gal patient when they show up for procedure x, y, or or zed. Well, do know what? 

I haven't. But now that you've told me, I will keep my eye my eye out and my ear around. Who knows? But thank you for for giving me the heads up. That's We'll just be glad you don't have these ticks in The UK, it sounds like. 

Yeah. I think we've got some ticks, but, you know, it probably wouldn't surprise you to know I don't spend much time hanging out in a forest, so I don't expose or or in grassy fields, so I don't expose myself to these things. Now Hot tub. Just the hot tub. Exactly. 

Now, actually, talking about emotional things, there was something that really, really struck a chord. And REK have had a a a thing every year where they give an unsung hero award. And, actually, the recipient from, from May 2023, was doctor MK Varman. He was an anesthetist, in Newcastle who's essentially fundamental in the development and delivery of regional anesthesia care and education in Newcastle. And he founded the NUSGRA, Newcastle ultrasound guided regional anesthesia, and the course that they did. 

Now sadly, he died in 2018. But for me, it was really emotional to see one of my colleagues, John O. Womack, who was taught by this, doctor Varma, get up on stage and introduce his daughter who came up to receive Yeah. To receive the award. So, you know, it's amazing. 

That was a really emotional, wasn't it? Emotional presentation. Yeah. So, you know, it's I think we're very lucky to be in a position to be able to, deliver education regional anesthesia, but, and and it's lovely to see potentially the legacy it can be left behind. I I was really that was lovely to see him being honored in in in such a manner, and that will certainly be a memory that I remember for, for a long, long time. 

It sounds like he was a a beloved member of the RA community. Yeah. Absolutely. Absolutely. I was just sad that I didn't get a chance to meet him myself. 

Yeah. In terms of other, you know, big big deals, so every year at RUK, you know, we have our keynote lecture, the Bruce Scott lecture. And, actually, Sandy Cott delivered that, that Bruce Scott lecture at RUK, and she covered things, mentorship, coaching, and leadership. So that was really interesting talk. I love to get an insight into to Sandy, her path to being where she is now, such a massive international name, and looking at people that inspired her. 

Yeah. That was I mean, the Bruce Scott lecture is is something I've looked forward to every time I've gone to the or attended virtually. Well, hold on a minute. You you were you were a Bruce Scott lecturer. Right? 

Yeah. I was. Back in 2014, I had that tremendous honor. You must have been, like, 25 then. Yeah. 

Yeah. Yeah. Yeah. I just I just look old. No. 

Sandy did an amazing job. And what I loved about her take on mentorship was the idea of sponsorship and and how because it wasn't a concept I had come across a lot and the idea that, you know, a mentor helps with professional and personal development. But a a sponsor is someone who pushes people using their whatever connections they have into positions where they can succeed and accelerates and smooths the track to achieve success. And so I thought it was a fantastic talk. She, you know, she does an amazing job with every talk she gives. 

Funny, heartwarming. You know, I actually texted Yeah. At the end of that lecture a person who I've had a I've been for we've talked about this before too, but I've had a I've been fortunate to have a lot of great mentors in my life. Uh-huh. But I there's one there's one that I I I hadn't, you know, talked to or reached out to or or seen in a long time, and I I texted him and said, hey. 

I just wanted to let you know, like, you played a huge pivotal role in in who I am today, and I I just wanna thank you. How lovely. And isn't it lovely that a talk can make you think about that and and and make sure you remember to to thank thank the people who made a difference? Yeah. Yeah. 

Yeah. Yeah. So thanks, Sandy. That was that was amazing. And there was one one of the session that kind of stuck out to me initially, and that was using regional anesthesia in intensive care. 

So this is something that, for my personal institution, I can see that it's changed over time. Certainly, when I was doing my initial training as an anesthetist, many of the intensivists weren't that big on on regional anesthesia. If you sent a patient to the ICU with an epidural, in reality, they wouldn't use it. It would only become an issue at the point when they think about extubating the patient well. By that stage, they turn the patient so many times the epidural would probably come out. 

So it was really lovely to hear, a few of our friends. We had Justin Kirk Bailey, Johnny, Johnny Wilkinson, and Ashley Miller, amongst many others, talking about how regional anesthesia can be used in intensive care. So and I've definitely seen a shift change, at our institution where people are asking for regional anesthesia. You know? Sternal fractures after CPR. 

Can is there anything you can do to help extubate? No. I know you've got you've had some some impact with regional anesthesia in ICU where you work. Right? Yeah. 

A little bit. I mean, we we I feel like we're doing more, We're being really aggressive with rib fractures just because the, you know, the mortality and morbidity associated with with multiple rib fractures in the elderly is just so significant. So we're we we try to jump on them with epidurals or paravertebral catheters or intercostal blocks or whatever we can use. And and, Dan, I wanna say maybe maybe an ESP to them in general. I have done. 

Yep. For sure. But I think there's a lot to your point, there's a lot more that we can do. I love the idea of blocks for sternal fractures after CPR, or, you know, rectus sheath catheters, for example, for laparotomy incisions and people that are just struggling to get off the vent. Yeah. 

Yeah. Hope a 100%. You know, I I think we're gonna see more regional anesthesia in ICU. What would be interesting now is also to see we're we're training a whole group of pure intensivists now in The UK. So they'll do an, intensive care path as their primary specialty. 

So they're already good with ultrasound, and it'd be interesting to see whether they take up that mantle of being able to deliver regional season themselves. So, you know, that's something to to watch this space. Hey. Listen. I thought we'd take a little break from the podcast now. 

I need to ask you a question. There's another you you may have heard that I I kind of like watching some stuff on TV. There's a show I wanted to ask you about. I was so happy that came back. I wanna know whether you watch it. 

Ted Lasso. Do you watch that? Yeah. Yeah. Watch Ted Lasso. 

It's it's a it's a great one. It was a perfect COVID show. Right? Because it was just so heartwarming and positive and uplifting. We made it through the first two seasons. 

Haven't seen season three yet, so don't no spoilers. Okay. No. It's worth it. It's definitely worth it. 

We watched that just now. That came back. I'm not gonna say anything, but it's definitely worth, worth committing to. What's interesting is even inspired there's a there's a there's a podcast called, explore the space podcast, and they've even created a hashtag med lasso. And they talk about lots of the parallels between Ted Lasso and and the medical community, and it's incredible to hear people dissect the podcast with a with a medical slant. 

So, if you get a chance, check out the, explore the space, podcast. They've they've got a few med lasso episodes, and they literally do dissections of each episode. So it's great. Definitely worthwhile checking out. Cool. 

I will. And the other thing that was cool, we we we gotta mention, at Ara UK, we had a mug competition winner. We did. The winner of our mug competition was Jenny Ferry. Yay, Jenny. 

So we managed to get, we managed to see her, give it to her in person. We created a small video that we put out on Twitter. That was great. That was and, also, we got to meet some of the people that have been following us for a while. So we got to meet, Amina Ben Yusuf. 

We got see her in person. That was cool. That was amazing. And what a what a cool story. Like, she had some travel issues and visa issues, and it's the last minute, it all came together. 

And she She managed to pull it out the bag. It looked like the world was conspiring against her to not let her get here, but she did everything in her power, she managed to get herself there. That was brilliant. And we've got to see Cass Andrews as well. Yeah. 

So, you know, we we got to meet lots of people. Listen. I got a couple of jokes for you, man. Okay. Can't agree. 

Here we go. Okay. So, we've talked about Tanya before, Gong Gas Girl from Twitter or X. Why did Tanya Selak not like regional anesthetics? Oh, I don't know. 

Because they got on her nerves. My god. Okay. Okay. Yeah. 

Yeah. We're we're going there. Okay. Listen. We we we got some we got some good friends, the Salisbees. 

Now the youngest Salisbee, is Charlotte. Now Charlotte Salisbee told me a joke the other day, and I had to include it. Okay? Kind of fits with some of the discussions we've been having already, regarding meat. And what do you call a cow with no legs? 

Cow with no legs? No. Don't know. Ground beef. Oh my god. 

Okay. K. So you want me something you got something for me? Yeah. Yeah. 

You know, a patient actually told me this one. I don't I like this one. I chuckled. Little little I did had a 10 year old kid the other day. Okay. 

What do clouds wear underneath their shorts? Oh my goodness. Oh, I really wanna try and get this. What do clouds wear underneath their shorts? Okay. 

I don't know. Tell me. Thunderpants. Oh my goodness. That's so good. 

Okay. That's really good. I'm gonna remember that. And the kid had the kid had this, like, great delivery too. I'm I'm wheeling him back. 

I think it was in bedazzling, partly, but, you know, he Okay. I I love that. Anything more we're gonna get back into the podcast? You tell me, man. No. 

Let's get back let's get back to it. For me Go on. I was the for me, the highlight of RE UK besides just seeing you Yes. Was our pro con debate. Dude, that was so much fun. 

Yeah. It was, I mean, I had looked forward to that for a for a long time and had had so much fun. So listeners, my esteemed opponent, Amit Pawa, and I had a debate about the value of nerve stimulation. Specifically, the question was, should trainees be taught how to use a nerve stimulator in 2023? And I took the pro side. 

Yes. They should be. And And I took the con. Yeah. Yep. 

Yep. You know, tears were shed. Friends became enemies. Enemies became friends. It was Let's just settle on with with frenemies. 

Right? And that's what we are. But listen. It was it was it was great fun because, you know, and I kinda I made a a point of talking about at the beginning. Ultimately, we want as many patients as possible to benefit from regional anesthesia. 

That and that's the key. So whatever it take the bottom line is whatever it takes to get it done, that's what should happen. But, you know, it it makes, an interesting debate certainly when I know that we are on different sides of the argument. We've got different feelings about it. That's not to say you may not have convinced me to switch sides. 

I I haven't said that officially. And I don't wanna give anything away, but there were some really quite entertaining highlights. And, again, I'm not gonna give anything away, but all I will say is I didn't say it. And you'll know what I mean when you see, the debate. So have you are we gonna do something with this debate? 

Are we gonna put it out on our channels? Well, a matter of fact, you can find this on our YouTube channel now. What? Seriously? Yeah. 

Yeah. Yeah. So if you wanna if you if you're if you have an extra thirty minutes, it's thirty minutes, and you wanna listen to and and watch the slides, the slide presentations from our our ProCon debate from RA UK on nerve stimulation, you can and and when you do, please go into the comments and vote for who you think won the debate. Oh my goodness. He's still trying to get votes. 

This is unbelievable. Yeah. No. Listen. You're you're absolutely right. 

It was so much it was fun preparing for it. I was a bit nervous because I was thinking you're such a great speaker anyway. And then with debates and and getting the whole audience on the side, I thought, how am I gonna have a a chance to win? But I tried my best. It was good fun. 

No. It was good fun. It was it was yeah. It was a highlight. It was amazing. 

And this is listen. So, so so so viewers and listeners can get hold of that from our YouTube respective YouTube channels. What else did you do on stage? Did you do anything else? I did a lecture on I was asked to give a lecture on the place of encapsulated bupivacaine or liposomal bupivacaine Uh-huh. 

In in regional anesthesia, which is obviously somewhat of a controversial topic at times for for whatever reason. But, you know, we've used it a bunch, and I was able to give sort my practical perspective on where it works and where it where you have to be a bit careful about it and that sort of thing. I think, you know, I think the biggest one of the problems with this medication is that the data is all over the place, frustratingly. And so one of the points I was trying to make in that short lecture was, in our experience, it is a medication that demands precision. So you can be a little bit sloppy on a TAP block with regular local anesthetics because they will cross, they'll diffuse through muscle and through fascial planes and eventually get to some of it will get to the nerves. 

With an encapsulated liposomal product, what we found the hard way is that it stays where you put it. So if you are one fascial plane away, the liposomes will stay in that in a plane that is not very effective. Now once it releases the bupivacaine, the bupivacaine will of course diffuse, but the effect site concentration is so low on purpose that that's where we see blocks fail and I've had plenty of blocks fail. Right. Because, you know, we were not absolutely careful about the precise plane. 

So that was a hard learned lesson that we've learned over years and and but it helps me understand why there's a discrepancy in the literature about, you know, and we take images and videos of of our blogs to for a couple of different reasons. But but one of things that allow has allowed us to do is go back and say, that block didn't work like I expected it to. And you go back and you're looking at, oh, yeah. Okay. That that's why we were the local with was just not in the right place. 

So the key is if you wanna use the drug, you've got to perform good regional anesthesia. It's gotta be accurate. You gotta put the drug in the right place. Yeah. Yeah. 

Exact I mean, that's such a good rule for for any any regional anesthetic procedure, but it but it I think the regular look on anesthetics are a little bit more forgiving. Gotcha. I've seen, you know, brachial plexus blocks that are a couple millimeters away from, you know, interscalene space and they still seem to work okay. That's not gonna happen with liposomal stuff. I was gonna say, it's funny. 

That's gonna that's gonna form part of another podcast that we're talk about exactly that whole thing. But, yeah, no. That would that was really so I missed that lecture, but I'm definitely gonna watch it on the catch up, so I'm looking forward to that. You know, there was another thing that I, that I really enjoyed. It kind of cements that whole getting together face to face, you and I, and and and and, yeah, and the fun doing it is we did, a scanning demo for the ideal regional anesthesia for for knee arthroplasty. 

And that was much fun. That felt like we were doing a live podcast. Right? We were in person. So that was that sort of in a in a in a way that this is different because we're not in the same place and we're we're having a communication. 

But that was like we were doing a live podcast in real time. That was so much fun. And I think there's gonna be a plan to release some of that footage at some stage. So that'll be great. And if we find out about that, we'll let you guys know for sure. 

Yeah. That was cool. We had a little a little model, and we were doing all the 17 blocks that we that we do for knees. And, it were Dude, it was 27, man. It was 27 blocks. 

Was there was there anything else as we're wrapping up this episode now? Was there anything else that stood out from the from the conference? I mean, there were so many good things. We obviously can't cover everything. Was there anything else that stuck out and, and you remembered thinking, oh, that was cool. 

It's nice to see that being talked about. I loved the the the POCA sessions were great too. And and, obviously, this is that's not a regional anesthesia topic per se, but, of course, it fits into our skill set so much with ultrasound. And so this to watch, they did a really, really good job of it. And and so, again, it was sort of live scanning. 

There's a bit of a presentation, and here's how you use POKUS for evaluating an airway. And then they went and scanned somebody's airway live on stage. And so we could you could see, okay. Yeah. That's not that hard, and you I see where that would be valuable. 

And it was amazing to see you saw lots of different people up on stage. You saw Bridget Poulos. You saw Rosie Hogg. You saw Kareem, Justin, Justin Kirk Bailey, Johnny Wilkinson. There's a whole group of dynamic pocus educators showing us how we could potentially incorporate pocus into our day to day practice and definitely inspired me to think, do you know what? 

I need to do this. I need to just understand. You gotta find a role and see how it may have a role in your practice, but, certainly, there are some elements perhaps more than others that make sense to me. So I think I'm gonna just crack on and get and get learning. Yeah. 

Absolutely. And, you know, I I just I just say as a as a sort of final comment, it it was just so well organized. The selection of the topics, the speakers, the the pacing of it, it was a really, really well done meeting. It's one of my one of my favorites in a long time. Definitely. 

Big congratulations to the organizing committee. We are so, we're so grateful to have been part of it and to be able to to contribute in some way to the education. But you know what? The meeting ended up with a little bit of a surprise. Do you remember? 

How could I forget? Yeah. So, folks, for 2024, REUK is coming to London. The the surprise for me, although I did know, was that the Bruce Scott lecture for 2024 is, is one of the presenters of this podcast, and it's not Jeff. He's already done it. 

That's amazing, man. I I, I congratulations. I am so excited to to hear what we have to say next year. Was London a surprise as well? So, there was a short list of potential places. 

So I so I knew Uh-huh. Just ahead of everybody else. But yeah. So there were a number of places they were looking at, and London had always been at some stage. It's always gonna come back to London at some stage. 

So the guys were and I'd you know, I had effectively, was leaving REK board. This was my last meeting as part of the REK board in in May 23. So the the organizing committee, for next year, Toby Ashkin and Maria Pasabastian, they were kind of talking about a few ideas with Alan. So they settled on London. When they, when they decided on London, I don't know how the process of voting for Bruce Scott has happened, but some process happened behind, and, and Alan came and delivered the news to me in person. 

So I was very, very chuffed. So well chuffed. So well deserved, man. I I I I am I am thrilled for you. And Thank you so much. 

It was really cool the way they did that. I mean, we know our ASA and ASRA venue schedule, like, five, six years out. I think it was really cool to keep this as sort of a surprise for a lot of the people and say, well, next year, it's gonna be in London. That's right. And the Bruce Scott lecture is I'm at power. 

Yeah. There was there was a promo video, which they did a lot of they great work with that promo video. So It was amazing. Listen. I feel a whole weight of expectation. 

I, and a lot of pressure because I've got a lot of incredible speakers I'm following after that I need to live up to, but I will try my best. So, folks, please put into your calendars second and third of May twenty twenty four. Our UK comes to London. Dude, that's a wrap on this episode. It's it was great to catch up with you. 

Yeah. It was lovely to see you in in person. It was great to meet so many of our friends in real life. How do you wanna wrap up this episode? I mean, I think we have to say thank you so much to all of you for continuing to listen to to us. 

We really appreciate it, truly. And if you can, would you please rate us wherever you get your pod? That would really help make this podcast available to lots of others who haven't discovered it yet. By now, we think you know where to follow us. But if you don't, if you're on x or Twitter, you can find us at at block it underscore hot underscore pod. 

Uh-huh. Our YouTube channel where you will find that procon debate is at block it like it's hot. Yeah. And thanks for leaving the hard one for me. Yeah. 

If you're on Instagram, you can follow us at block underscore it underscore like underscore it's underscore hot. Block it like it's hot with underscores in between the word. And don't forget on Twitter, we got a hashtag block it like it's hot. So please get involved with the conversations online, and and let us know what you wanna talk about. We got some great episodes coming up, Jeff. 

It's great to be back. It's so good to be back in the studio with you, man. What do you say, Jeff? Till the next time. We hope they all Block it like it's hot.