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https://www.selleckchem.com/products/ademetionine.html Introduction Patient resistance to local anesthetics is rarely considered as the cause of regional anesthesia failure. Case report We report a case of resistance to local anesthetics in a patient with Crohn's disease who underwent cesarean section under continuous spinal anesthesia. Discussion Resistance to local anesthetics may be more common than we think, especially among patients with chronic pain. Providers should consider local anesthetic resistance when regional anesthesia is unsuccessful. Further research is needed to determine if skin wheal tests and/or a different local anesthetic could improve results.Background and objectives Educational initiatives are a sustainable means to address provider shortages in resource-limited settings (RLS), yet few regional anesthesia curricula for RLS have been described. We sought to design a reproducible training model for RLS called Global Regional Anesthesia Curricular Engagement (GRACE), implement GRACE at an RLS hospital in Ghana, and measure training and practice-based outcomes associated with GRACE implementation. Methods Fourteen of 15 physician anesthesiologists from the study location and three from an outside orthopedic specialty hospital consented to be trainees and trainers, respectively, for this prospective single-center observational study with pre-post evaluations. We conducted an initial needs assessment to determine current clinical practices, participants' learning preferences, and available resources. Needs assessment findings, expert panel recommendations, and investigator consensus were then used to generate a site-specific curriculum that was implemented during two 3-week periods. We evaluated trainee satisfaction and changes in knowledge, clinical skill, and peripheral nerve block (PNB) utilization using the Kirkpatrick method. Results The curriculum consisted of didactic lectures, simulations, and clinical instruction to teach ultrasound-guid

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