A Pilot In Vitro Evaluation of the “Air Test” for Perineural Catheter Tip Localization by a Novice Regional Anesthesiologist

Abstract

The "air test" is used clinically to infer perineural catheter location and has been recently evaluated for use by experts. However, its utility for practitioners with less experience is unknown. We tested the hypothesis that the air test, when performed by a novice regional anesthesiologist, will improve assessment of perineural catheter tip position in a validated porcine-bovine model and determined the test's positive and negative predictive values, sensitivity, and specificity for a novice. In contrast to the results of the expert study, the air test did not improve the novice's assessment of perineural catheter tip location over chance.

Comparative-Effectiveness of Simulation-Based Deliberate Practice Versus Self-Guided Practice on Resident Anesthesiologists’ Acquisition of Ultrasound-Guided Regional Anesthesia Skills

“…The ADAPT group designed a "hybrid" simulator using meat, muscle tendons, and a mannequin to best simulate a femoral nerve block approach and used this model in previous published studies. 16,26 The ADAPT group, anecdotally, has not received any user criticism to the fidelity of their model to date. Yet, it is possible that teaching with another simulator in a similar population may produce different results.…”

“…The hybrid simulator consisted of an upper body mannequin (Laerdal SimMan, Wappingers Falls, New York) and a porcine tissue model with embedded bovine tendon placed at the thigh of the mannequin that simulated a peripheral nerve on ultrasound. 16 Baseline UGRA performance of a simulated, femoral nerve block was captured by video ( Fig. 2) and later scored in a blinded fashion by 2 fellowship-trained experts in regional anesthesia.…”

Color Doppler ultrasonography of an agitated solution is predictive of accurate catheter placement for a continuous popliteal sciatic nerve block

“…An agitated solution also can be created, using the air/local anesthetic solution previously described, with a single 20- or 30-mL syringe by pulling the plunger back several times and releasing it in rapid succession to produce the agitated solution. Other methods of catheter localization that exist, visualizing either a small 20-gauge catheter or hypoechoic perineural volume expansion, can be challenging (Takatani et al, 2012 ; Johns et al, 2014 ). Agitated injection paired with color Doppler is an imminently practical solution to locating a PNC after placement, requiring readily available materials and standard ultrasound machine settings.…”

Simulation in teaching regional anesthesia: current perspectives

“… 45 – 55 Examples include primarily case reports on devices or techniques such as Luer connectors, echogenic needles, needle guides, “air test” for inferring perineural catheter tip location, and a hand-on-syringe technique. 47 – 50 , 52 , 53 Only Kilicaslan et al, 49 Whittaker et al, 45 Neal et al, 46 Johnson et al, 47 and Gupta et al 48 provide effectiveness data. Simulation itself is not evaluated for efficacy, and studies that include a control group expose both the control and intervention groups to the simulated environment.…”