Abstract ID: A33
Abstract Title: The Learning Curve For Infraclavicular Nerve Block Using A Regional Anesthesia Simulator.
Poster Type: Poster
ABSTRACT BODY
Introduction:The infraclavicular nerve block is used commonly for surgery involving the distal arm. Using a high fidelity simulator (Regional Anesthesia Teaching Initiative), we developed a scenario to examine the learning curve for resident physicians with varying experiences placing infraclavicular nerve block. The ultimate goal is to improve patient safety by providing a teaching model for trainees that will allow them to gain experience and the knowledge necessary to place an infraclavicular block on live patients that is both safe and effective. We believe that this model will enable trainees the opportunity to learn and master safe procedural technique, as well as its appropriate indications, while developing an understanding of anatomy for brachial plexus blocks.
Materials and Methods:Resident physicians, from all levels of training in the Department of Anesthesiology at Duke University, were asked to participate in this study. An equal number of participants from each class were involved. A case scenario was developed and a subset of questions was presented to each trainee. The questions were generated by a group of experienced regional anesthesiologists and represent the core knowledge required for safe efficient practice of infraclavicular nerve block. Responses were recorded and each trainee was given sufficient time to answer the questions. The main objectives were to examine knowledge of proper anatomy, use of appropriate monitoring, recognition of appropriate nerves stimulated for an infraclavicular block, knowledge of the brachial plexus anatomy, number of needle passes to obtain an appropriate nerve stimulus, knowledge of appropriate indications for this type of block, appropriate dosing and choice of local anesthetics, and correct use of the nerve stimulator. The time that it took for the participants to place a block was also examined.
After their initial trial, each participant repeated the nerve block and scenario multiple times, with each attempt being no less than 3 days after the previous attempt. The time interval allowed the trainee time to read and learn about the block and research any answer that he or she was unsure about. The trainee was given the same scenario and questions each time he or she placed the block.
Results:We found that trainees with varying experience demonstrated improved knowledge and skill when placing an infraclavicular nerve block using the model. Also, the trainees demonstrated a decrease in the time it took to achieve appropriate nerve stimulation. There was also a decrease in the number of needle passes.
Discussion:Although we frequently place infraclavicular nerve blocks at out institution, the number that it would take a trainee to gain the knowledge and skill necessary to become proficient with its placement may not be achieved during the resident’s training. This high fidelity simulator allowed novice as well as more experienced trainees the opportunity to learn hands on the appropriate use of this type of block as well as helping to develop the technical skills necessary for placing this block. We hypothesize that this will relate to improved outcomes (both in safety and effectiveness) for patients who are candidates for this block.
ATTACHED FILES
Reg Anesth Pain Med 2004; 29(2):A33