The creation of an objective assessment tool for ultrasound-guided regional anesthesia using the Delphi method.

BACKGROUND AND OBJECTIVES: The assessment of technical skills in ultrasound-guided regional anesthesia is currently subjective and relies largely on observations of the trainer. The objective of this study was to develop a checklist to assess training progress and to detect training gaps in ultrasound-guided regional anesthesia using the Delphi method. METHODS: A 30-item checklist was developed and then e-mailed to 18 reviewers for feedback. The checklist was modified on the basis of their feedback. This process of iteration was repeated until no further feedback was received, and a consensus was reached on the final composition of the checklist. A global rating scale (GRS) was introduced as a result of the feedback. RESULTS: Three rounds of feedback were required to reach consensus on the composition of the checklist and the GRS. The final checklist contains 22 items, and the GRS contains 9 categories. CONCLUSIONS: Using the Delphi method, a checklist and GRS were developed. These tools can serve as an objective means of assessing progress in ultrasound technical skills acquisition.

Anesthesia residents' preference for learning interscalene brachial plexus block (ISBPB): traditional Winnie's technique vs. ultrasound-guided technique.

There is a recent shift from traditional nerve stimulation (NS) to ultrasound-guided (UG) techniques in regional anesthesia (RA). This shift prompted educators to readdress the best way to teach these two modalities. Development of a more structured curriculum requires an understanding of student preferences and perceptions. To help in structuring the teaching curriculum of RA, we examined residents' preferences to the methods of instruction (NS Vs. UG techniques). Novice residents (n=12) were enrolled in this parallel crossover trial. Two groups of 6 residents received a didactic lecture on NS or UG techniques. The groups then crossed over to view the other lecture. After they observed a demo of ISBPB on two patients using NS and US. The residents completed a questionnaire regarding their impression of each technique and the learning experience. UG technique was perceived to be safer and to have more educational value than NS. However, residents felt both techniques should be mandatory in the teaching curriculum.

Acquisition of technical skills in ultrasound-guided regional anesthesia using a high-fidelity simulator.

Despite the increasing popularity of ultrasound-guided regional anesthesia (UGRA), structured training programs during residency are often lacking. The lack of a regional block area, lack of expertise, and lack of structured training programs have limited hands-on experience in residency programs. However, these constraints may be circumvented through the use of simulation. This observational study looked at the use of a high-fidelity simulator for training novice undergraduate students UGRA techniques. Despite some improvement in the second trial with the simulator, the ability to maintain visualization of their needle (p<0.05), align needle with probe (p<0.05), and angle their needle approach (p<0.05), as well as reduce needle passes (p<0.05) did not improve. The results show students had difficulty learning skills requiring more coordination and fine motor control.

A comparison of sartorius versus quadriceps stimulation for femoral nerve block: a prospective randomized double-blind controlled trial.

BACKGROUND: Femoral nerve block is widely used for regional anesthesia and analgesia in many lower limb operations. Peripheral nerve stimulation of the femoral nerve may elicit 1 of 2 responses: contraction of the sartorius muscle through stimulation of its muscular branch or contraction of the quadriceps muscle through stimulation of its respective muscular branches. Historically, a quadriceps response has been preferred. We hypothesized that the success of femoral nerve block using a sartorius muscle evoked motor response is equivalent to that using quadriceps muscle twitch response. This prospective randomized double-blind controlled trial compared sartorius or quadriceps muscle evoked motor response as the end point for stimulation for femoral nerve block. METHODS: Seventy-two patients scheduled for primary unilateral total knee arthroplasty were randomly assigned to undergo femoral nerve block using either the sartorius or the quadriceps evoked muscle response as an end point of stimulation. Motor block of the femoral and sensory block of the femoral, saphenous, and lateral femoral cutaneous nerves were assessed. The primary outcome was the quality of motor and sensory block of the femoral nerve 30 minutes after injection of 20 mL of 0.5% ropivacaine. Secondary outcomes were duration of femoral nerve block, time required to perform the nerve block, total dose of hydromorphone patient-controlled analgesia, and postoperative pain by visual analog score 24 hours after block insertion. In addition, the spread of local anesthetic and the position of the needle in relation to the femoral nerve were assessed by means of ultrasonography. RESULTS: There were no statistically significant differences in the proportion of patients with either complete alone or complete and partial block combined between quadriceps and sartorius groups 30 minutes after block insertion; femoral nerve (P = 0.49; P = 0.13), the saphenous nerve (P = 0.64; P = 0.21), or the lateral femoral cutaneous nerves (P = 0.2; P = 0.35). Patient-controlled analgesia hydromorphone consumption was significantly higher in the group that underwent sartorius muscle stimulation ([mean ± SD] 4.9 ± 3.6 mg [range, 0-13.2 mg] vs 3.1 ± 2.7 mg [range, 0-10.0 mg]; P = 0.024). CONCLUSION: Our study demonstrated that using sartorius or quadriceps evoked muscle twitch as an end point of stimulation was associated with an equivalent degree of femoral nerve block.