Teaching trainees neuraxial anaesthesia. What is the evidence?

Abstract

Central neuraxial blockade (CNB) describes a range of procedures that are used to provide perioperative anaesthesia and/or analgesia for patients undergoing a wide variety of surgical procedures. It represents a significant proportion of workload for both anaesthetists and those in training. The most effective method(s) for teaching and training novice anaesthetists to perform CNB remains unclear. This paper presents a systematic review of the literature and recommendations for educational techniques in clinical practice. A systematic review of the literature was undertaken. Medline, PubMed, ERIC, Cochrane library, PsycInfo, and HMIC databases were searched from inception to June 2018 for studies involving CNB skills teaching. Searches were limited to the English language and full text availability. Studies were analysed and quality scored using the MERSQI scale [1]. Outcomes for each intervention were also plotted against a modified Kirkpatrick's model. 14 papers (n=14) were included in the review. The mean MERSQI score was 12.43 (range 8.5-16). 9 of the studies had a MERSQI score above 12. The studies reported a range of educational and clinical outcomes; the modal outcome was improved knowledge and/or skills (2b). Interventions identified were the use of Ultrasound (2 studies), Educational multimedia (4 studies), Simulation (8 studies), Feedback delivery (1 study), Mental imagery (1 study), and Learning curves (1 study). The use of ultrasound imaging and simulated clinical practice demonstrated the most significant effects on trainee knowledge and skill; however, studies were generally small, and as both methods and outcomes showed marked heterogeneity, large scale, high quality studies would be beneficial to this important aspect of anaesthetic practice.

Impact of Ultrasound–Assisted Method on Success Rate of Spinal Anesthesia Performed by Novice Trainees: A Retrospective Comparative Study

“…This study aimed to validate the safety and efficacy of the educational possibilities of US-guided spinal anesthesia versus the LG technique, performed by novice trainees in patients with a difficult spine approach (such as patients with scoliosis, spinal deformities, and obesity), as often occurs in an orthopedic setting. So far, only a few studies have investigated different methods for teaching regional anesthesia to novice trainees, assessing the rate of success or comparing the discomfort, performing time, and complications between Ultrasound-Assisted spinal anesthesia and Landmark-Guided spinal anesthesia [24][25][26][27][28]. In this study, we analyzed the effects of diagnostic US imaging on success rates of spinal anesthesia and the risk of procedural complications.…”