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.

This article qualitatively assesses and summarizes randomized, controlled studies regarding benefits of ultrasound (US) for brachial plexus block and also examines those studies that have compared different brachial plexus block techniques using US.Studies were identified by a search of PUBMED and EMBASE databases using the MeSH terms anesthetic techniques, brachial plexus, and ultrasound. Included studies were limited to randomized trials that compared a US technique with another accepted method of performing brachial plexus block or those studies that compared 2 different US-guided techniques. Studies were further classified according to methodological quality using accepted methods. Quality scores were compared using Mann-Whitney U test, and significance assumed at P < 0.05.Twenty-five studies met inclusion criteria, with 19 studies comparing US techniques with other nerve location methods and 6 studies comparing different US techniques. Of the former, there was convincing evidence to support the use of US, with 15 of 19 studies demonstrating improved outcomes compared with existing techniques.Ultrasound provides significant advantages when performing brachial plexus block including faster sensory block onset and greater block success.

Background and ObjectivesChecklists and global rating scales (GRSs) are used for assessment of anesthesia procedural skills. The purpose of this study was to evaluate the reliability and validity of a recently proposed assessment tool comprising a checklist and GRS specific for ultrasound-guided regional anesthesia.MethodsIn this prospective, fully crossed study, we videotaped 30 single-target nerve block procedures performed by anesthesia trainees. Following pilot assessment and observer training, videos were assessed in random order by 6 blinded, expert observers. Interrater reliability was evaluated with intraclass correlation coefficients (ICCs) based on a 2-way random-effects model that took into account both agreement and correlation between observer results. Construct validity and feasibility were also evaluated.ResultsThe ICC between assessors’ total scores was 0.44 (95% confidence interval, 0.27–0.62). All 6 observers scored “experienced trainees” higher than “inexperienced trainees” (median total score 76.7 vs 54.2, P = 0.01), supporting the test’s construct validity. The median time to assess the videos was 4 minutes 29 seconds.ConclusionsThis is the first study to evaluate the reliability and validity of a combined checklist and GRS for ultrasound-guided regional anesthesia using multiple observers and taking into account both absolute agreement and correlation in determining the ICC of 0.44 for interrater reliability. There was evidence to support construct validity.