Jeff: Thank you for the kind words and asking how we are doing. Everything is good, it is a tough time, and we are doing as well as everybody else in anesthesiology can be doing. Doing #Blocktober was a reaction to a lot of the stress and daily grind that we were having to go through. We certainly are looking forward to turning the page on the calendar next month.

Amit: So how did you come up with the Concept of #Blocktober?  Also, Why not #Nervember or #August-Bier month?!  

Jeff: I like the “nod to history” with August-Bier month, and so wish I had thought of Nervember! I have to give credit to one of our trainees here, a resident by the name of Dr. Bryan Chow, who was doing his regional rotation last year (2019). I asked him at the beginning of the month, “Are you ready for Rock-tober?” and he replied, “Don’t you mean “Blocktober?!” At that point, everyone in the block area said “Oh my God, that is so amazing, why didn’t we think of that?!” So, I made a mental note and decided I had to do something with that at some future date, but that is as far as it went last year. As we got closer to fall this year (2020), it came to my brain that we should do something with it.

Amit: What was the trigger, why did you decide to do #Blocktober?

Jeff: I think honestly, I was missing that interaction with people, hands-on workshops, and teaching, like we all are. This year has highlighted for me just how much that is a big part of my life – going to these meetings and hanging out with my work friends and my anesthesia family. Our group was looking for a way to band together and create something that was fun and engaging – so that is how it came together in the early fall of 2020.

Amit: This clearly took a lot of time and effort to create. How long did the whole process take? How much preparation was involved? How long did it take to produce one day’s content?

Jeff: I would love to tell you that we started in the summer and we had it all planned out and filmed ready to go ahead of time…but honestly the idea to do it and “push out” daily content really came together two weeks ahead of time. We scrambled and thought “What would it be like if we actually did this for a month?” There was a lot of enthusiasm, and we got a draft schedule of what we wanted to do about a week ahead of time which meant the first three days we were able to do in advance, but by day three, we were only doing things one day ahead of time. It was fun, but there were some late nights video editing for sure, and my wife said that she was a “blocktober-widow” and would see me in November!

Amit: Coming up with something to talk about for 31 days is quite a challenge and in the process of doing so, you have created a virtual textbook and treasure trove of information. How did you decide what topics/blocks to cover?

Jeff: When we were making a schedule, that exact thought occurred to us too. I was telling a friend who is not an anesthesiologist about the idea and he said “Are there even 31 blocks?!” Certainly, the explosion of fascial plane blocks helped as it meant we could do serratus plane blocks one day, PECS on another. Some days we decided to focus on a particular aspect of a technique rather than the technique in general. For example, on the adductor canal day, we really wanted to focus on the concept of putting local anesthetic at both the nerve to vastus medialis and to the saphenous nerve. We were keen that there should not be just 31 block videos, so, there were a couple of education topics, some lecture-type videos on histology and nerve injury, and of course the crossword and image contest too! We managed to fill 31 days for sure.

Amit: What was your favorite topic or learning point and why?

Jeff: I think the phrenic-sparing shoulder blocks was my favorite one because I ended up doing a lot of reading and learning about the techniques and innervation, and I was happy with how the figures on the innervation turned out. A side benefit of this whole venture was how much I learned over the whole month. Despite the fact that a lot of the videos were very technique-heavy and didn’t require me to dig really deep into evidence, I did include some recent or important papers so I had to make sure what I was saying was correct and ended up learning a great deal on the process too.

Amit: What tools did you use to create your videos?

Jeff: I have always been a fan of Keynote for Mac, and a lot of the animations where the nerves come down around the back of the knee for example, were all created using the Keynote software. The video editing was all performed using Final Cut Pro. I am by no means an expert now, but my video editing skills have come along such a long way now, that my family videos stand a chance of being half-way decent.

Amit: Why do you think it is so important to keep educating our colleagues about regional anesthesia? What do you see as being the main role that regional anesthesia plays in the provision of patient care in the future?

Jeff: You and I are in the thick of it; we live and breathe nerve blocks and regional anesthesia and so it is sometimes hard to see outside our own world. There is this real disconnect between what blocks you can do for patients in terms of outcomes, and how many people are actually using them. We have data from the United States that people keep bringing up (it’s getting a bit old now, and I’d love to see some more updated data), but 25% of orthopaedic cases are getting blocks and the rest aren’t – that is just sad. There is clearly a lot of room to grow there in terms of delivering education. One of the barriers to performing these blocks is simply - education, with people stating “I was never trained in how to do these blocks” – and “It’s too late for me now.” Those are potentially the people that we can reach now with some of these educational initiatives.

When you see things like - regional anesthesia lead to improved AV fistula graft patency – that is a really important outcome, and we are seeing more of those things. There is a lot of room to grow still.

Amit: We are clearly all missing face-to-face meetings and real-life educational activities. With life as it is at present, do you see these types of strategies being the future of regional anesthesia education, and medical education in general?

Jeff: I think there is a role there. As I was saying, one of the reasons we did this was because we missed the face-to-face meetings. I don’t think we will ever get away from being in the same room as somebody, showing them how to do a technique, or chatting with them. The interactivity part of it is crucial to getting concepts across to people. Clearly there is a gap that can be filled by putting out video content and making it easily accessible to anyone. That was one of the most gratifying things about #Blocktober – seeing how far and wide we were able to reach and hopefully provide value for people all over the world. We were not just teaching our trainees at our institution, or at an ASRA or ESRA meeting, locally or regionally. It was truly global.

Amit: How has your social media following grown as a result of #Blocktober? How will you use your ever-growing influence moving forward? 

Jeff: I was actually reflecting the other day that I did my very first tweet sitting beside you at an RA-UK meeting in 2014! I actually went back to my very first tweet, and I was in the audience with you! It is also really gratifying that I have made connections with some awesome people, and there was a level of interactivity for me personally behind the scenes too. People would “direct message” me and ask me to expand on a concept, or ask me to send references. It was really rewarding to make new friends. I started #Blocktober at about 1,700 followers, and now have about 2,700.

In the final video, we mentioned that we promised we would keep up the tweets and posts – we are committed to that. We feel like we have done something kind of interesting here, and it would be good to keep on delivering. So, stay tuned for some more interesting stuff from Duke RAP.

Amit: Do you have any idea or concept of the social media reach of #Blocktober?

Jeff: I have good data on the YouTube videos because that data is discreet. The impressive thing was that it was truly on six different continents. We were getting engagement from Europe, Africa, Australasia, Asia, South America, and North America. It was great that you could put something “out there” and people would get back to you from all over the world. The YouTube page has been growing steadily since we started posting videos, and we have around 1,100 subscribers now. I had been keeping an eye on the view of the erector spinae plane (ESP) video as it was gaining some traction, and one day the views suddenly increased by 400 views. I realized that must have been the day you lectured to the Royal College of Anaesthetists and shared the link!

Amit: What was the most popular day and subject?

Jeff: That has been interesting. The most popular videos were interspace between popliteal artery and capsule of the knee (IPACK), ESP, and adductor canal. I am not sure if that relates to the education-gap and what people feel that they don’t have enough information on. I think this is the case for IPACK as there have not been a whole host of studies on it. Alternatively, it may just relate to subjects that are “red-hot” like the ESP block.

Amit: It was great fun taking part in the crossword for the prize of “Duke Swag”! I am sure there was a very worthy winner! (conflict of interest – I won!) Have you got plans for more quizzes and contests moving forward?

Jeff: Your prize is on the way, Amit! That is one of the things we are excited about as part of our plan to keep the momentum going – creating easy-to-do but engaging opportunities. The crossword competition was one, and the image competition was the other. It was mind-blowing with the image competition to see the quality of what people are saving and all their submitted entries.

Amit: I have got to ask about the rap that you performed on the final day of #Blocktober! That was really something. Did you write the lyrics? How many takes did it take to get done? What was your favorite line?

Jeff: Yes, I wrote all the lyrics. I do like poetry and rhyme, and I have always been a rap and hip-hop fan. I used to have a hip-hop radio show when I was in medical school called “Hip-Hopnosis,” so it is always in the back of my mind. I wrote the rap a couple of days ahead of time, and my wife and I recorded it on the night of October 30^th. I then spent most of that night editing it, and we released it the next morning. It was a fun way to cap off the month for sure, and there were lots of out-takes and bloopers. My favorite line was rhyming “bolus” with “medial malleolus!” We had a ton of laughs that day in the block area filming the scenes. I’ve watched the clip with my colleague David Macleod “make it rain” with Tegaderms hundreds of times, and still laugh out loud with his commitment and intensity.  

Amit: Finally, the world is going to want to know, what have you got lined up for 2021?

Jeff: I don’t want to give away anything, but we are planning for #Blocktober-2021 so stay tuned. We also have a new series out now called “Coffee Chat with Duke RAP” so also keep an eye out for that. The first episode is out already. We are aiming to have casual chats with regional anesthesia influencers and personalities from around the globe, so that should be interesting.

The featured content and material can be found by searching the hashtag #Blocktober on Twitter and by viewing the videos on the Regional Anesthesiology and Acute Pain Medicine channel on YouTube. To see the breadth of topics covered, view the 2020 schedule.

Amit Pawa, MBBS, is a consultant anaesthetist at Guy's & St Thomas’ NHS Foundation Trust, London, UK where he is the lead for regional anaesthesia.

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Jeff Gadsden, MD, FRCPC, FANZCA, is a staff anesthesiologist at Duke University Hospital in Durham, NC.