Ultrasound-guided regional anesthesia performance in the early learning period: effect of simulation training.

BACKGROUND AND OBJECTIVES Success in performing ultrasound-guided peripheral nerve blockade (PNB) demands sound knowledge of sonoanatomy, good scanning techniques, and proper hand-eye coordination. The objectives of our study were to evaluate whether simulator training aids success of novice operators in ultrasound-guided PNB and to determine what number of procedures is required to attain proficiency. METHODS Twenty Postgraduate Year 2 anesthesiology residents with no previous experience in ultrasound-guided PNB were randomly assigned into 2 groups. Both groups received conventional teaching comprising of 4 didactic lectures on PNBs with ultrasound guidance. Using a low-fidelity simulation model, 1 group further received an hourlong training session on needling and proper hand-eye coordination. Once the training was over, the residents started their rotation through our block room. Using a logbook, each resident recorded the number of successful and failed ultrasound-guided regional anesthesia blocks performed over a 3-week period. A successful block was defined as one that was effective for surgical anesthesia and performed within 15 mins, with only verbal guidance from a staff anesthesiologist. Cumulative summation charts were created to track progress using a predetermined acceptable failure rate of 30%. RESULTS The conventional training group had 98 successful blocks, and the simulation group had 144 (51.3% vs 64%; P = 0.016). In the conventional training group, 4 of 10 residents achieved proficiency, and in the simulation training group, 8 of 10 residents achieved proficiency (80% vs 40%; P = 0.0849). CONCLUSIONS Simulation training improves success rate in ultrasound-guided performance of regional anesthesia.