1
|
King SA, Salerno A, Flanagan KJ, Euerle BD. Mixed-Model Curriculum for Nerve Block Education in Emergency Medicine Residency. Cureus 2023; 15:e37621. [PMID: 37197129 PMCID: PMC10185297 DOI: 10.7759/cureus.37621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/19/2023] Open
Abstract
Introduction With the rising opioid epidemic, there has been a push for multimodal pain management within the emergency department. Nerve blocks have been shown to be an effective pain management strategy for many conditions, with improved success when used with ultrasound. However, there is no generally accepted method for teaching residents how to perform nerve blocks. Materials and methods Seventeen residents from a single academic center were enrolled. The residents were surveyed pre-intervention regarding demographics, confidence, and use of nerve blocks. The residents then completed a mixed-model curriculum that included an electronic module (e-module) on three plane nerve blocks and a practice session. Three months later, residents were tested on their ability to independently perform the nerve blocks and resurveyed regarding confidence and use. Results Of the 56 residents in the program, 17 enrolled in the study; 16 participated in the first session, and nine participated in the second session. Each resident had < four ultrasound-guided nerve blocks prior to participation with a slight increase in the total number of nerve blocks after the sessions. Residents were able to perform, on average, 4.8 of seven tasks independently. Residents who completed the study reported feeling more confident in their ability to perform ultrasound-guided nerve blocks (p = 0.01) and to complete associated tasks (p < 0.01). Conclusion This educational model resulted in residents completing the majority of tasks independently with improved confidence in ultrasound-guided nerve blocks. There was only a slight increase in clinically performed blocks.
Collapse
Affiliation(s)
- Samantha A King
- Emergency Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Alexis Salerno
- Emergency Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Kevin J Flanagan
- Emergency Medicine, University of Maryland School of Medicine, Baltimore, USA
| | - Brian D Euerle
- Emergency Medicine, University of Maryland School of Medicine, Baltimore, USA
| |
Collapse
|
2
|
Liu M, Salmon M, Zaidi R, Nagdev A, Debebe F, Muller MF, Ruhangaza CF, Emiru H, Belachew Y, Tumebo A, Paoletti M, Okrainec A, Chan V, Niazi AU. Ultrasound-guided regional anesthesia: feasibility and effectiveness of teaching via telesimulation in Ethiopia. Reg Anesth Pain Med 2021; 46:722-726. [PMID: 33903219 DOI: 10.1136/rapm-2020-102394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/10/2021] [Accepted: 04/14/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Acute pain management in resource-poor countries remains a challenge. Ultrasound-guided regional anesthesia is a cost-effective way of delivering analgesia in these settings. However, for financial and logistical reasons, educational workshops are inaccessible to many physicians in these environments. Telesimulation provides a way of teaching across distance by using simulators and video-conferencing software to connect instructors and students worldwide. We conducted a prospective study to determine the feasibility of ultrasound-guided regional anesthesia teaching via telesimulation in Ethiopia. METHODS Eighteen Ethiopian orthopedic and emergency medicine house staff participated in telesimulation teaching of ultrasound-guided femoral nerve block. This consisted of four 90-min sessions, once per week. Week 1 consisted of a precourse test and a presentation on aspects of performing a femoral nerve block, weeks 2 and 3 were live teaching sessions on scanning and needling techniques, and in week 4, the house staff undertook a postcourse test. All participants were assessed using a validated Global Rating Scale and Checklist. RESULTS Participants were provided with a validated checklist and global rating scale as a pretest and post-test. The participants showed significant improvement in their test scores, from a total mean of 51% in the pretest to 84% in their post-test. CONCLUSIONS Teaching ultrasound-guided regional anesthesia of the femoral nerve remotely via telesimulation is feasible. Telesimulation can greatly improve the accessibility of ultrasound-guided regional anesthesia teaching to physicians in remote areas.
Collapse
Affiliation(s)
- Monica Liu
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | - Rene Zaidi
- InnovationsCZ, Goma, Congo (the Democratic Republic of the)
| | - Arun Nagdev
- Emergency Department, Alameda County Medical Center, Oakland, California, USA
| | - Finot Debebe
- Emergency Department, Black Lion Hospital, Addis Ababa, Oromia, Ethiopia
| | - Mundenga Furaha Muller
- Department of Orthopedics, HEAL Africa Hospital, Goma, Congo (the Democratic Republic of the)
| | - Cito Furaha Ruhangaza
- Department of Orthopedics, HEAL Africa Hospital, Goma, Congo (the Democratic Republic of the)
| | - Haimanot Emiru
- Emergency Department, Black Lion Hospital, Addis Ababa, Oromia, Ethiopia
| | - Yonas Belachew
- Emergency Department, Black Lion Hospital, Addis Ababa, Oromia, Ethiopia
| | - Aklilu Tumebo
- Emergency Department, Black Lion Hospital, Addis Ababa, Oromia, Ethiopia
| | | | - Allan Okrainec
- Department of General Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vincent Chan
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Ahtsham U Niazi
- Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Singh N, Ponde V, Jagannathan B, Rao PB, Dixit A, Agarwal G. Development and validation of a Questionnaire to study practices and diversities in Plexus and Peripheral nerve blocks. Indian J Anaesth 2021; 65:197-201. [PMID: 33776109 PMCID: PMC7989482 DOI: 10.4103/ija.ija_1161_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/27/2020] [Accepted: 02/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background and Aims Regional anaesthesia techniques are a part of perioperative medicine that affects both perioperative and long-term outcomes. We have a paucity of the data on the usage and practices of plexus and peripheral nerve blocks (PNBs). To the best of our knowledge, this is the first effort to validate a survey for plexus and PNBs. Subsequently, this questionnaire could be used for the survey to look for the trends and disparities in PNB practices and further to develop a national registry in the future. Methods Thirty questions were prepared after evidence-based search and reviewed by experts for suggestions. Changes were done and the questionnaire with the grading sheet was sent to 19 experts. The responses were analysed to calculate the content validity index (CVI) item-wise (I-CVI), scale-wise (S-CVI), and modified kappa statistics. The I-CVI of 0.78 and an S-CVI/average of 0.90 was taken as acceptable with more than six experts. Results Fourteen experts out of 19 assessed and graded the questions as per the provided sheet and submitted suggestions through the mail. Question reframing, option reconsideration, and change from single to multiple choices were incorporated as per the suggestions of the experts. Mean I-CVI for relevance, simplicity, clarity, and ambiguity was 0.99, 0.98, 0.98, and 0.99, respectively. S-CVI/average was 0.98, 0.97, 0.98, and 0.99 for relevance, simplicity, clarity, and ambiguity, respectively. Conclusion We conclude that this questionnaire has met the content validity criteria and can be used to study plexus and PNBs practices.
Collapse
Affiliation(s)
- Neha Singh
- Department of Anaesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | - Vrushali Ponde
- Department of Anaesthesia, Surya Children Hospital, Mumbai, Maharashtra, India
| | | | - Parnandi B Rao
- Department of Anaesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India
| | - Amit Dixit
- Department of Anaesthesia, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Gaurav Agarwal
- Department of Anaesthesia, Care Hospital, Bhubaneswar, Odisha, India
| |
Collapse
|
4
|
Trasolini NA, Bolia IK, Kang HP, Essilfie A, Mayer EN, Omid R, Gamradt SC, Hatch GF, Weber AE. National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure. Orthop J Sports Med 2020; 8:2325967120929349. [PMID: 32637432 PMCID: PMC7313342 DOI: 10.1177/2325967120929349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background There are few large database studies on national trends in regional anesthesia for various arthroscopic shoulder procedures and the effect of nerve blocks on the postoperative rate of opioid prescription filling. Hypothesis The use of regional nerve block will decrease the rate of opioid prescription filling after various shoulder arthroscopic procedures. Also, the postoperative pattern of opioid prescription filling will be affected by the preoperative opioid prescription-filling history. Study Design Cohort study; Level of evidence, 3. Methods Patient data from Humana, a large national private insurer, were queried via PearlDiver software, and a retrospective review was conducted from 2007 through 2015. Patients undergoing arthroscopic shoulder procedures were identified through Current Procedural Terminology codes. Nerve blocks were identified by relevant codes for single-shot and indwelling catheter blocks. The blocked and unblocked cases were age and sex matched to compare the pain medication prescription-filling pattern. Postoperative opioid trends (up to 6 months) were compared by regression analysis. Results We identified 82,561 cases, of which 54,578 (66.1%) included a peripheral nerve block. Of the patients who received a block, 508 underwent diagnostic shoulder arthroscopy; 2449 had labral repair; 4746 had subacromial decompression procedure; and 12,616 underwent rotator cuff repair. The percentage of patients undergoing a nerve block increased linearly over the 9-year study period (R 2 = 0.77; P = .002). After matching across the 2 cohorts, there was an identical trend in opioid prescription filling between blocked and unblocked cases (P = .95). When subdivided by procedure, there was no difference in the trends between blocked and unblocked cases (P = .52 for diagnostic arthroscopies; P = .24 for labral procedures; P = .71 for subacromial decompressions; P = .34 for rotator cuff repairs). However, when preoperative opioid users were isolated, postoperative opioid prescription filling was found to be less common in the first 2 weeks after surgery when a nerve block was given versus not given (P < .001). Conclusion An increasing percentage of shoulder arthroscopies are being performed with regional nerve blocks. However, there was no difference in patterns of filled postoperative opioid prescriptions between blocked and unblocked cases, except for the subgroup of patients who had filled an opioid prescription within 1 to 3 months prior to shoulder arthroscopy. Future research should focus on recording the amount of prescribed opioids consumed in national databases to reinforce our strategy against the opioid epidemic.
Collapse
Affiliation(s)
- Nicholas A Trasolini
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ioanna K Bolia
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Hyunwoo P Kang
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Anthony Essilfie
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Erik N Mayer
- Department of Orthopaedic Surgery, University of California-Los Angeles, Los Angeles, California, USA
| | - Reza Omid
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Seth C Gamradt
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - George F Hatch
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alexander E Weber
- USC Epstein Family Center for Sports Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
5
|
Snyman J, Goldstein LN. Nervous breakdown! A registry of nerve blocks from a South African emergency centre. Afr J Emerg Med 2019; 9:177-179. [PMID: 31890480 PMCID: PMC6933158 DOI: 10.1016/j.afjem.2019.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/09/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Nerve blocks are commonplace in the operating theatre and have recently made their way into emergency centres as a viable alternative to traditional methods of analgesia. Their use and safety has been documented for a variety of pathologies and it has been shown that they spare opioids and shorten time to discharge. No data exists on their use in South Africa. The purpose of this study was to analyse data from an existing nerve block registry from an emergency centre in South Africa. METHODS The study was a retrospective, descriptive analysis of a nerve block registry from an academic emergency centre in Johannesburg, South Africa from May 2016 to September 2017. RESULTS There were 168 nerve blocks performed by 36 different operators of varying experience. The most common indication was for fracture management and the most frequently performed blocks were femoral 3-in-1 (44.6%), pop-sciatic (16.7%) and forearm-ultrasound nerve blocks (16.7%). Ultrasound guidance was used in 88.6% of the blocks. The average time taken to perform a nerve block was 10 min. The success rate was 91.8%. None of the variables analysed (i.e., operator experience, type of nerve block performed, time taken to perform the nerve block, ultrasound guidance, amount of anaesthetic used and time taken to evaluate outcome) had any effect on the success rate. CONCLUSION This study illustrates the use of nerve blocks as an effective, safe and timeous analgesic solution to a wide variety of musculoskeletal injuries in an academic emergency centre in South Africa.
Collapse
Affiliation(s)
- Jenna Snyman
- Division of Emergency Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | |
Collapse
|
6
|
Abstract
Pain management in acute orthopedic injury needs to be tailored to the presentation and patient. Subjective and objective assessment, in conjunction with pathophysiology, should be used to provide symptom control. Ideally, treatment should be administered in an escalating fashion, attempting to manage pain with the lowest dose of the safest medication available. There are also adjunctive therapies, including those that are nonpharmacologic, that can provide additional relief.
Collapse
Affiliation(s)
- Nupur Nischal
- Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Evangeline Arulraja
- Division of Emergency Medicine, Duke University Medical Center, Durham, NC, USA
| | - Stephen P Shaheen
- Emergency Medicine and Orthopedic Surgery, Division of Emergency Medicine, Department of Orthopedic Surgery, Duke University Medical Center, DUMC Box 3096, Durham, NC 27710, USA.
| |
Collapse
|
7
|
|