Ultrasound-Guided Regional Anesthesia Simulation Training

Stellate ganglion nerve blockade (SGNB) is a vital tool in our armamentarium for the treatment of various chronic pain syndromes. SGNB can be performed using the traditional landmark-based approach, or with image guidance using either fluoroscopy or ultrasound. In this review, we systematically analyzed reported SGNB-related complications between 1990 and 2018. Seven databases were queried for SGNB between January 1, 1990 and November 27, 2018. Search results of the complications associated with SGNB were reported as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Out of a total of 1909 articles, 67 articles met our inclusion criteria, yielding 260 cases with adverse events. In 134 of the 260 (51.5%) cases, SGNB was performed with image guidance. Sixty-four (24.6%) and 70 (26.9%) of the complication cases reported the use of ultrasound and fluoroscopy guidance, respectively. One hundred and seventy-eight (68.4%) patients had medication-related or systemic side effects, and 82 (31.5%) had procedure-related or local side effects. There was one report of death due to massive hematoma leading to airway obstruction. There was one case report of quadriplegia secondary to pyogenic cervical epidural abscess and discitis following an SGNB. Complications following SGNB have been reported with both landmark-based techniques and with imaging guidance using fluoroscopy or ultrasound. In our systematic review, most adverse events that were reported occurred during or shortly after SGNB. Vigilance, American Society of Anesthesiologists standard monitors for conscious sedation, and accessibility to resuscitation equipment are vital to the safe performance of SGNB.

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“…Simulation training may hold the key to achieving this formidable task 64. Image guidance continues to be widely accepted.…”

Section: Discussionmentioning

confidence: 99%

Complications associated with stellate ganglion nerve block: a systematic review

Goel

Patwardhan

Ibrahim

et al. 2019

Reg Anesth Pain Med

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“…Practice for regional anesthesia via simulation training may improve needle handling and facilitate the localization of targets [6][7][8]. Simulation training can entail virtual reality, bench model simulators, human cadavers, and animal carcasses [8].…”

Section: Introductionmentioning

confidence: 99%

Impact of simulation-based anesthesiology training using an anesthetized porcine model for ultrasound-guided transversus abdominis plane block

Park

Kim

Yang

et al. 2018

Preprint

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Background: Anesthetized pigs may be useful for training with regional anesthesia techniques. This model animal was used to assess the impact of simulation-based training for ultrasound-guided transversus abdominis plane (TAP) block. Methods: In this prospective study, 23 participating residents (10 in their second year, 13 in their third year) underwent simulation-based training for ultrasound-guided TAP block. The residents completed standard questionnaires comprising ten multiple-choice questions regarding essential general knowledge of abdominal ultrasound and TAP block before and after the training session. On a five-point Likert scale, they reported their levels of comfort with the use of ultrasound and block equipment, subject/operator positioning, proper block technique, image documentation, needle handling, and anxiety, as well as their overall confidence with the procedure. Results: Compared with those before training, the comfort levels of the residents significantly improved for all measures, except needle handling (all P < 0.05). The participants also indicated significantly reduced anxiety for performing the TAP block technique (P < 0.05). Conclusion: The use of anesthetized pigs in simulation-based training for the ultrasound-guided TAP block procedure improves the procedural knowledge and confidence while reducing the associated anxiety in anesthesiology trainees. Keywords: Porcine; simulation-based training; transversus abdominis plane block

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“…A need exists to develop accurate and reliable metrics that quantify translation of regional anaesthesia skills. A recent systematic review demonstrated large heterogeneity for type of participants, mode of simulation, and outcome 1 . Metrics include task and error checklists, eye gaze tracking, and global rating scores.…”

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confidence: 99%

“…The presence of trans-laryngeal or tracheostomy tubes impairs communication, leading to frustration and anxiety for patients and staff, and dissatisfaction with care. 1 Augmentative and alternative communication (AAC) includes a range of strategies and devices intended to facilitate communication. 2 With technology developing rapidly we conducted a literature review of AAC strategies to inform our research in this field.…”

mentioning

confidence: 99%

Construct validation of metrics for translation of regional anaesthesia skills from the soft embalmed cadaver to patients

Sadler

McKendrick

Taylor

et al. 2019

British Journal of Anaesthesia

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mapping extended beyond their normal pain area and the L5 dorsal rami was found to be the most common nerve whose mapping extended the pain beyond the usual area. The areas not covered by suprathreshold stimulation were much higher than expected areas for the stimulated nerves, implying the need for stimulation at higher level. Thus we conclude that it is possible to reliably map the painful area using suprathreshold stimulation such that the procedure may be used to select the nerve for radiofrequency denervation in future. Acknowledgement BJA/RCoA iBSc John Snow award to KF.

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Ultrasound-Guided Regional Anesthesia Simulation Training

Abstract: Ultrasound-guided regional anesthesia knowledge and skills significantly improved with simulation training. The acquired UGRA skills may be transferred to the clinical setting; however, further studies are required to confirm these changes translate to improved patient outcomes.

Cited by 60 publications

References 24 publications

Complications associated with stellate ganglion nerve block: a systematic review

Complications associated with stellate ganglion nerve block: a systematic review

Impact of simulation-based anesthesiology training using an anesthetized porcine model for ultrasound-guided transversus abdominis plane block

Construct validation of metrics for translation of regional anaesthesia skills from the soft embalmed cadaver to patients

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