Anesthesiologists’ learning curves for ultrasound assessment of the lumbar spine

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Purpose The objective of this continuing professional development module is to describe the role of ultrasound for spine demarcation before placement of neuraxial blocks and to provide a comprehensive systematic approach towards ultrasound scanning in obstetric patients. Principal findings Ultrasound imaging of the lumbar spine has been shown to be effective in improving the success rate of neuraxial blocks in obstetric patients. The success rate of ultrasound-guided epidural insertions at first attempt was found to be 30-60% greater when compared with the traditional epidural method. Pre-puncture ultrasound scanning can provide reliable and accurate information on several critical aspects needed for successful epidural placement, such as the interspace level, the midline of the spine, the optimal puncture point, the optimal angle for needle insertion, and the depth to the epidural space. Ultrasound scanning of the lumbar spine can generate images in two distinct patterns -one in the transverse plane represented by a ''flying bat'' and the other in the paramedian longitudinal plane represented by a ''saw-tooth'' configuration. Both approaches allow the visualization of the ligamentum flavum and the dura mater in addition to other adjacent bony landmarks. A stepwise scanning approach can serve as a useful guide to facilitate the successful placement of epidural needles in patients with both normal and abnormal spinal anatomy. Conclusions Incorporating the use of lumbar spine ultrasound scanning into day-to-day clinical practice may improve the ease of performing epidurals as well as add to patient safety and comfort.

Section: Efficacy Of Ultrasound-guided Techniquesmentioning

confidence: 99%

Section: Scolioseunclassified

Locating the epidural space in obstetric patients—ultrasound a useful tool: Continuing Professional Development

Balki

2010

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“…4 Participants in their study were provided reading material and an educational video on ultrasound-facilitated spinals and epidurals that they were required to review prior to a 45-min lecture. This was followed by a 15-min demonstration on a live model and a 30-min hands-on workshop in a small group setting.…”

Section: Discussionmentioning

confidence: 99%

“…4 There are two aspects to the skills involved in conducting a pre-puncture scan: 1) the cognitive skills of interpreting the ultrasound images and identifying the anatomic structures seen in the images and 2) the manual skills of manipulating the ultrasound probe to achieve clear images of the structures and of marking the skin to indicate the intervertebral spaces and the midline of the spine to guide needle insertion.…”

Section: Résumémentioning

confidence: 99%

The use of an online three-dimensional model improves performance in ultrasound scanning of the spine: a randomized trial

Niazi

Carvalho

Chan

2013

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Purpose The use of ultrasound for neuraxial blockade is a new application of technology that is rapidly becoming accepted as a standard of care. This new skill has shown to improve success, but it is a challenge to teach. To assist with teaching the use of ultrasound in regional anesthesia of the lumbar spine, we have developed an interactive educational model (http://pie.med.utoronto.ca/vspine or http://www.usra.ca/vspine.php). In this study, we aimed to determine whether use of this model for a two-week period would improve the performance of novice operators in determining defined landmarks during real-time ultrasound imaging of the lumbar spine. Methods We evaluated the educational benefit of the ultrasound module by randomly assigning 16 postgraduate firstyear (PGY1) anesthesia residents to either a control group with password-protected access to only the lumbar anatomy module or to an intervention group with access to the complete module. All residents had access to the module for two weeks following a full-day workshop that is part of the university teaching program which consists of a didactic lecture on ultrasoundfacilitated neuraxial anesthesia, mentored teaching on cadaveric spine dissections, and hands-on ultrasound scanning of live models. At the end of the two weeks, the performance of the residents was evaluated using a 12-item task-specific checklist while carrying out a scout scan on a live model. Results The control group had a median score of 5.5 (25 th percentile: 4, 75 th percentile: 18), while the intervention group had a median score of 11.5 (25 th percentile: 8, 75 th percentile: 12) in the task-specific checklist, with a significant difference of 6 (confidence interval 1.5 to 10.5) between groups (P = 0.021). Conclusion Our results show superior performance by the residents who had access to both components of the module, indicating that access to the interactive ultrasound spine module improves knowledge and skills prior to clinical care.

“…5,[27][28][29][30] In one study, cusum was used to determine the amount of training required to achieve competency in spinal ultrasound. 27 The conclusion was that 20 attempts and a coaching session were not sufficient to teach the relevant skills, and that this should inform the planning of future educational sessions and workshops. Unlike most other papers, no feedback was given during the attempts, which meant that all learning was experiential once the trial began.…”

Section: Ultrasound Skillsmentioning

confidence: 99%

Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum)

Starkie

Drake

2013

Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum) É valuation de la formation en habiletés techniques et de la performance en anesthésie au moyen de l'analyse des sommes cumulées (cusum) Abstract Purpose The current methods (work based assessments and logbooks) used to assess procedural competency and performance have well-documented deficiencies. Cumulative sum analysis (cusum), a statistical method that generates performance graphs over time, is an alternative tool that is not currently widely used. The purpose of this review is to investigate its current role in anesthetic procedural skills training and performance.Tim