The American Society Of Regional Anesthesia and Pain Medicine and the European Society Of Regional Anaesthesia and Pain Therapy Joint Committee recommendations for education and training in ultrasound guided regional anesthesia: why do we need these guidelines?

Ultrasound-Guided Vascular Access Simulator for Medical Training: Proposal of a Simple, Economic and Effective Model

OBJECTIVE

To present a simple and affordable model able to properly simulate an ultrasound-guided venous access.

DESIGN

The simulation was made using a latex balloon tube filled with water and dye solution implanted in a thawed chicken breast with bones.

RESULTS

The presented model allows the simulation of all implant stages of a central catheter. The obtained echogenicity is similar to that observed in human tissue, and the ultrasound identification of the tissues, balloon, needle, wire guide and catheter is feasible and reproducible.

CONCLUSION

The proposed model is simple, economical, easy to manufacture and capable of realistically and effectively simulating an ultrasound-guided venous access.

Performance accuracy of hand-on-needle versus hand-on-syringe technique for ultrasound-guided regional anesthesia simulation for emergency medicine residents

Introduction

Ultrasound-guided nerve blocks (UGNB) are increasingly used in emergency care. The hand-on-syringe (HS) needle technique is ideally suited to the emergency department setting because it allows a single operator to perform the block without assistance. The HS technique is assumed to provide less exact needle control than the alternative two-operator hand-on-needle (HN) technique; however this assumption has never been directly tested. The primary objective of this study was to compare accuracy of needle targeting under ultrasound guidance by emergency medicine (EM) residents using HN and HS techniques on a standardized gelatinous simulation model.

Methods

This prospective, randomized study evaluated task performance. We compared needle targeting accuracy using the HN and HS techniques. Each participant performed a set of structured needling maneuvers (both simple and difficult) on a standardized partial-task simulator. We evaluated time to task completion, needle visualization during advancement, and accuracy of needle tip at targeting. Resident technique preference was assessed using a post-task survey.

Results

We evaluated 60 tasks performed by 10 EM residents. There was no significant difference in time to complete the simple model (HN vs. HS, 18 seconds vs. 18 seconds, p=0.93), time to complete the difficult model (HN vs. HS, 56 seconds vs. 50 seconds, p=0.63), needle visualization, or needle tip targeting accuracy. Most residents (60%) preferred the HS technique.

Conclusion

For EM residents learning UGNBs, the HN technique was not associated with superior needle control. Our results suggest that the single-operator HS technique provides equivalent needle control when compared to the two-operator HN technique.

[Ultrasound-guided axillary brachial plexus block: learning curve and results]

BACKGROUND AND OBJECTIVE

The use of ultrasound in regional anesthesia requires the acquisition of new knowledge and skills not only by anesthesiologists in training but also by anesthesiologists experienced in neurostimulation-guided peripheral nerve blocks. We studied the effect of training on 2 anesthesiologists who were skilled in neurostimulation-guided regional anesthesia.

PATIENTS AND METHODS

Observational, controlled study of the first 45 ultrasound-guided axillary blocks of the brachial plexus performed by two anesthesiologists with expertise in the neurostimulation-guided axillary procedure. For analysis of results, groups of 15 patients from each anesthesiologist were assigned consecutively (G15, G30 and G45). We assessed the duration of the block procedure, the incidence of vascular puncture and effectiveness of the block.

RESULTS

The mean (SD) duration of the procedure was 547 (16) seconds in G15. It was significantly lower in G30 and G45 (893 [104] seconds and 397 [111] seconds). The incidence of vascular puncture dropped significantly after completion of the first 15 blocks, from 20% in 615 to 3% in G30 and 0% in G45. The results of the block procedure also significantly improved after the first 15 blocks: 89% effectiveness in 615, 93% in G30, and 100% in G45. The variables assessed were similar for the 2 anesthesiologists.

CONCLUSIONS

For an anesthesiologist with experience establishing a conventional axillary brachial plexus block using a nerve stimulator, 15 ultrasound-guided axillary blocks are required before good results can be expected with the new procedure.