Abdominal surgery can cause significant postoperative pain and associated morbidity. Systemic opioids often contribute to side-effects such as sedation, respiratory depression, nausea and vomiting. Postoperative epidural analgesia offers superior analgesia and reduced pulmonary morbidity compared to systemic analgesia 1 , however several reports have alluded to a recent decline in its utilisation following abdominal surgery 2-4. This has occurred on a background of large clinical trials that have failed to demonstrate improved survival following major surgery 1,5 and large studies focusing on morbidity due to epidural analgesia 6-8. Although neurological disability following central neuraxial block is rare, medicolegal concerns can dominate clinical decision-making regarding anaesthesia options. Postoperative epidural analgesia requires ongoing clinical care and surveillance, whereas systemic opioids may have less demand on clinical resources. Furthermore, there is a current trend towards minimally invasive surgical procedures, hence an increasing role for emerging less invasive analgesia techniques. One less invasive analgesic technique is transversus abdominis plane (TAP) block. This technique involves injection of local anaesthetic into the fascial plane between internal oblique and transversus abdominis muscles, where the thoracolumbar nerves T6 to L1 course before innervating the anterior abdominal wall 9. Results from three randomised control trials, utilising anatomical landmark techniques have

SummaryThe aim of this study was to create and evaluate the validity, reliability and feasibility of the Regional Anaesthesia Procedural Skills tool, designed for the assessment of all peripheral and neuraxial blocks using all nerve localisation techniques. The first phase was construction of a 25-item checklist by five regional anaesthesia experts using a Delphi process. This checklist was combined with a global rating scale to create the tool. In the second phase, initial validation by 10 independent anaesthetists using a test-retest methodology was successful (Cohen kappa ≥ 0.70 for interrater agreement, scores between test to retest, paired t-test, p > 0.12). In the third phase, 70 clinical videos of trainees were scored by three blinded international assessors. The RAPS tool exhibited face validity (p < 0.026), construct validity (p < 0.001), feasibility (mean time to score < 3.9 min), and overall reliability (intraclass correlation coefficient 0.80 (95% CI 0.67-0.88)). The Regional Anaesthesia Procedural Skills tool used in this study is a valid and reliable assessment tool to score the performance of trainees for regional anaesthesia.

SummaryAssessment tools must be investigated for reliability, validity and feasibility before being implemented. In 2013, the Australian and New Zealand College of Anaesthetists introduced workplace-based assessments, including a direct observation of a procedural skills assessment tool. The objective of this study was to evaluate the psychometric properties of this assessment tool for ultrasound-guided regional anaesthesia. Six experts assessed 30 video-recorded trainee performances of ultrasound-guided regional anaesthesia. Inter-rater reliability, assessed using absolute agreement intraclass correlation coefficients, varied from 0.10 to 0.49 for the nine individual nine-point scale items, and was 0.25 for a 'total score' of all items. Internal consistency was measured by correlation between 'total score' and 'overall performance' scale item (r = 0.68, p < 0.001). Construct validity was demonstrated by the 'total score' correlating with trainee experience (r = 0.51, p = 0.004). The mean time taken to complete assessments was 6 min 35 s.

During intubation under general anaesthesia, LP-G resulted in greater cervical movement than FB when no cervical immobilization was used in adults without cervical disease. Airway manoeuvres performed before FB, especially jaw thrust, also resulted in cervical spine movement.

Trainees became competent in ultrasound needle visualization at a variable rate. This study estimates that novices would require approximately 28 supervised trials with feedback before competency in ultrasound needle visualization is achieved.