Regional anesthesia global health collaborations- a scoping review of current intervention methods.

PURPOSE OF REVIEW: Perioperative anesthesia-related mortality is significantly higher in low-resource compared to high-resource countries. Regional anesthesia techniques can provide safety, cost, and access benefits when compared to general anesthesia in these settings but is underutilized primarily due to a lack of experienced educators and training opportunities. Academic institutions and international organizations are attempting to fill this educational gap through collaborations, but these efforts need examination for best practices going forward. RECENT FINDINGS: Most collaborative anesthesia interactions between high and low resource areas have occurred between North America or Europe, and Africa or Asia and a majority have involved an educational intervention. Only 7% of the studies used a recognized framework to evaluate the intervention used in their research, such as the Kirkpatrick, REAIM or CFIR method. All recent studies reviewed reported a positive impact from educational collaborations. Only 7% of interventions have had a primary focus on regional anesthesia and most were reported between 2016 and 2022. SUMMARY: Robust reports on international collaborations providing capacity enhancing educational interventions in regional anesthesia have increased in recent years but are still rare and should be encouraged going forward. Short courses supported by high-resource countries can be effective in low-resource areas when partnerships produce curricula that are well designed.

Regional anesthesia training model for resource-limited settings: a prospective single-center observational study with pre-post evaluations.

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-guided PNB for limb injuries. Pre-post evaluations showed trainees were satisfied with GRACE, median knowledge examination score improved from 62.5% (15/24) to 91.7% (22/24) (p<0.001), clinical examination pass rate increased from 28.6% (4/14) to 85.7% (12/14) (p<0.01), and total PNB performed in 3 months grew from 48 to 118. CONCLUSIONS: GRACE applied in an RLS hospital led to the design, implementation, and measurement of a regional anesthesia curriculum tailored to institutional specifications that was associated with positive Kirkpatrick outcomes.

Cervical spine disease is a risk factor for persistent phrenic nerve paresis following interscalene nerve block.

The use of interscalene blocks (ISBs) for shoulder surgery improves postoperative pain control, reduces recovery room times, and reduces overall hospital stays. The most common and potentially disabling adverse effect associated with ISBs is phrenic nerve paresis. Fortunately, persistent phrenic nerve paresis (PPNP) is rare. There are only 4 case reports of PPNP in the English literature. At our institution, we identified 9 cases of PPNP over a 9-year period, representing an incidence of 1 (0.048%) in 2069. In conducting a case-control series, we found that symptomatic cervical spine disease is a risk factor for the development of PPNP. Patients with PPNP had a significantly higher incidence of cervical spine disease (85.7%) compared with the control group (30.9%), P < 0.01. Persistent phrenic nerve paresis remains a perplexing complication of ISB, and many questions remain unanswered. Our data identify an important risk factor that can aid in the risk stratification of patients undergoing ISB.