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Murray K, Akinleye O, Siddiqui A, Xu J, Dominguez J, Delbello D, Salik I. Socioeconomic disparities and trends in the utilization of regional and neuraxial anesthesia for pediatric femur fracture repair. Injury 2025; 56:112086. [PMID: 39705904 DOI: 10.1016/j.injury.2024.112086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Revised: 12/10/2024] [Accepted: 12/11/2024] [Indexed: 12/23/2024]
Abstract
Pediatric femur fractures often necessitate surgical intervention, with pain management being critical for both immediate and long-term outcomes. Peripheral nerve blocks (PNBs) and neuraxial techniques are effective in providing targeted pain relief while minimizing systemic opioid exposure. Despite their benefits, the utilization of these anesthesia techniques in pediatric orthopedic surgeries is limited, particularly among socioeconomically disadvantaged patients. This study aims to evaluate the association between socioeconomic status (SES) and the use of regional and neuraxial anesthesia in pediatric femur fracture repairs, focusing on healthcare resource utilization (HRU) outcomes such as hospital length of stay (LOS), total hospital charges, and discharge disposition. Using the 2016-2020 NIS database, we identified 43,605 pediatric patients who underwent femur fracture repair. Only 1 % received PNB, and 0.1 % received spinal block (SB). Our analysis revealed that PNB was less likely to be administered to patients from lower SES backgrounds, those with subtrochanteric fractures, or those requiring delayed repair. Conversely, PNB was associated with reduced HRU, while SB was linked to increased HRU. The findings underscore significant disparities in the application of regional anesthesia, influenced by socioeconomic factors. Our study highlights the need for standardized guidelines and interventions to address these disparities, ensuring equitable access to effective pain management techniques in pediatric orthopedic care. Further research is warranted to understand the barriers to the utilization of PNB and to develop strategies to enhance its adoption, particularly among underserved populations.
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Affiliation(s)
- Kelsey Murray
- New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, USA.
| | - Oluwatoba Akinleye
- New York Medical College, 40 Sunshine Cottage Rd, Valhalla, NY 10595, USA.
| | - Ammar Siddiqui
- Westchester Medical Center, Anesthesiology, Pain Management, 100 Woods Rd, Valhalla, NY 10595, USA.
| | - Jeff Xu
- Westchester Medical Center, Regional Anesthesiology, Pain Management, 100 Woods Rd, Valhalla, NY 10595, USA.
| | - Jose Dominguez
- Westchester Medical Center, Neurosurgery, 100 Woods Rd, Valhalla, NY 10595, USA.
| | - Damon Delbello
- Westchester Medical Center, Orthopedic Surgery, 100 Woods Rd, Valhalla, NY 10595, USA.
| | - Irim Salik
- Westchester Medical Center, Anesthesiology, 100 Woods Rd, Valhalla, NY 10595, USA.
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Kowa CY, Morecroft M, Macfarlane AJR, Burckett-St Laurent D, Pawa A, West S, Margetts S, Haslam N, Ashken T, Sebastian MP, Thottungal A, Womack J, Noble JA, Higham H, Bowness JS. Prospective randomized evaluation of the sustained impact of assistive artificial intelligence on anesthetists' ultrasound scanning for regional anesthesia. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2024; 6:e000264. [PMID: 39430867 PMCID: PMC11487881 DOI: 10.1136/bmjsit-2024-000264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 09/10/2024] [Indexed: 10/22/2024] Open
Abstract
Objectives Ultrasound-guided regional anesthesia (UGRA) relies on acquiring and interpreting an appropriate view of sonoanatomy. Artificial intelligence (AI) has the potential to aid this by applying a color overlay to key sonoanatomical structures.The primary aim was to determine whether an AI-generated color overlay was associated with a difference in participants' ability to identify an appropriate block view over a 2-month period after a standardized teaching session (as judged by a blinded assessor). Secondary outcomes included the ability to identify an appropriate block view (unblinded assessor), global rating score and participant confidence scores. Design Randomized, partially blinded, prospective cross-over study. Setting Simulation scans on healthy volunteers. Initial assessments on 29 November 2022 and 30 November 2022, with follow-up on 25 January 2023 - 27 January 2023. Participants 57 junior anesthetists undertook initial assessments and 51 (89.47%) returned at 2 months. Intervention Participants performed ultrasound scans for six peripheral nerve blocks, with AI assistance randomized to half of the blocks. Cross-over assignment was employed for 2 months. Main outcome measures Blinded experts assessed whether the block view acquired was acceptable (yes/no). Unblinded experts also assessed this parameter and provided a global performance rating (0-100). Participants reported scan confidence (0-100). Results AI assistance was associated with a higher rate of appropriate block view acquisition in both blinded and unblinded assessments (p=0.02 and <0.01, respectively). Participant confidence and expert rating scores were superior throughout (all p<0.01). Conclusions Assistive AI was associated with superior ultrasound scanning performance 2 months after formal teaching. It may aid application of sonoanatomical knowledge and skills gained in teaching, to support delivery of UGRA beyond the immediate post-teaching period. Trial registration number www.clinicaltrials.govNCT05583032.
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Affiliation(s)
- Chao-Ying Kowa
- Department of Anaesthesia, The Royal London Hospital, London, UK
| | - Megan Morecroft
- Faculty of Medicine, Health & Life Sciences, University of Swansea, Swansea, UK
| | - Alan J R Macfarlane
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | | | - Amit Pawa
- Department of Medicine and Perioperative Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Simeon West
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Nat Haslam
- Department of Anaesthesia, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Toby Ashken
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
| | - Maria Paz Sebastian
- Department of Anaesthetics, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Athmaja Thottungal
- Department of Anaesthesia and Pain Management, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | - Jono Womack
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | | | - Helen Higham
- Nuffield Department of Clinical Anaesthesia, University of Oxford, Oxford, UK
- Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - James S Bowness
- Department of Anaesthesia, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Targeted Intervention, University College London, London, UK
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Standifird C, Triplett HE, Bassett C, Norman K, Ames E, Levy J, Moreno M, Lauria M, Sulkowski K, Simanton E, Kang E. Development of a Cost-Effective and High-Fidelity Gel Model for Peripheral Ultrasound-Guided Intravenous Access Training. Cureus 2024; 16:e70181. [PMID: 39463578 PMCID: PMC11506811 DOI: 10.7759/cureus.70181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2024] [Indexed: 10/29/2024] Open
Abstract
Introduction Simulation tools are crucial in medical education but current commercial models for ultrasound-guided intravenous (IV) access lack complexity and can be prohibitively expensive. This article proposes a cost-effective gel model system that replicates realistic vein and artery interactions, addressing the limitations of traditional models. An advanced gelatin model was constructed that incorporates intricate vein and artery configurations and enhances medical training by providing a more authentic experience. Patient testing will further validate its efficacy, promising improved accessibility for skill refinement in resource-constrained environments. Methods In a controlled study at the Kirk Kerkorian School of Medicine at the University of Nevada, Las Vegas, 12 medical students with limited ultrasound experience participated in a workshop using novel and Blue Phantom™ models for ultrasound-guided IV catheter placement. The advanced gelatin model, created with Ziplock™ Tupperware®, ultrasonography gel-filled balloons, and gelatin, proved more effective, as assessed by participants' post-training comfort levels. The comparison of participants' pre- and post-training comfort levels with the models was the primary study objective. Participants were asked to complete a confidence survey based on a five-point Likert scale, and after using both models, this survey was re-administered to assess the participant's level of comfort after model use. The statistical analysis comparison of post-training survey data to the pre-training survey data was accomplished using SPSS version 29 (IBM Corp, Armonk, NY), where a paired t-test was set at a significance threshold of p <0.05. Results Analysis of data from both commercially made and advanced ultrasound-guided IV models using a paired t-test revealed a significant advantage for the advanced model. Participants, despite limited ultrasound experience, reported feeling over 4 points higher in skill confidence (p = 0.004) with the advanced model. Its popularity stems from diverse vasculature modeling, proving effective for both experienced practitioners and inexperienced individuals, maintaining value as user skill levels increase. Conclusion This study proposes an advanced model for ultrasound-guided peripheral IV access training, demonstrating a statistically significant increase in confidence levels. Despite limitations such as small sample size and single-site participation, the advanced model's adaptability and cost-effectiveness make it a strong contender for replacing current commercial models, potentially enhancing proficiency and confidence while reducing costs.
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Affiliation(s)
- Colin Standifird
- Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV (University of Nevada, Las Vegas), Las Vegas, USA
| | - Hunter E Triplett
- Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV (University of Nevada, Las Vegas), Las Vegas, USA
| | - Charlton Bassett
- Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV (University of Nevada, Las Vegas), Las Vegas, USA
| | - Kaden Norman
- Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV (University of Nevada, Las Vegas), Las Vegas, USA
| | - Emily Ames
- Emergency, Kirk Kerkorian School of Medicine at UNLV (University of Nevada, Las Vegas), Las Vegas, USA
| | - Joshua Levy
- Emergency Medicine, Kirk Kerkorian School of Medicine at UNLV (University of Nevada, Las Vegas), Las Vegas, USA
| | - Marvi Moreno
- Radiology, University Medical Center of Southern Nevada, Las Vegas, USA
| | - Michael Lauria
- Emergency Medicine, University of Washington, Seattle, USA
| | - Kathryn Sulkowski
- Emergency Medicine, Mike O'Callaghan Military Federal Medical Center, Nellis Air Force Base, USA
| | - Edward Simanton
- Medical Education, University of Nevada Las Vegas School of Medicine, Las Vegas, USA
- University of Nevada Las Vegas, Office of Medical Education, Las Vegas, USA
| | - Eugene Kang
- Emergency Medicine, University Medical Center of Southern Nevada, Las Vegas, USA
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Grant SA, Kopp S, Albrecht E. Research priorities in regional anaesthesia: where should we focus? Br J Anaesth 2024; 133:1-2. [PMID: 38702237 DOI: 10.1016/j.bja.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/15/2024] [Accepted: 04/08/2024] [Indexed: 05/06/2024] Open
Abstract
Using a modified Delphi technique, an international group of regional anaesthetists generated a list of top research priorities in regional anaesthesia. The list of unanswered research questions was created from a questionnaire completed by >500 anaesthetists and distilled into 11 priorities grouped into four themes: clinical practice and efficacy, pain management, technology and equipment, and training and assessment.
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Affiliation(s)
- Stuart A Grant
- Department of Anesthesiology, University of North Carolina, Chapel Hill, NC, USA.
| | - Sandy Kopp
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Eric Albrecht
- Department of Anesthesiology Lausanne University Hospital, Lausanne, Switzerland
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Bowness JS, Liu X, Keane PA. Leading in the development, standardised evaluation, and adoption of artificial intelligence in clinical practice: regional anaesthesia as an example. Br J Anaesth 2024; 132:1016-1021. [PMID: 38302346 DOI: 10.1016/j.bja.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
A recent study by Suissa and colleagues explored the clinical relevance of a medical image segmentation metric (Dice metric) commonly used in the field of artificial intelligence (AI). They showed that pixel-wise agreement for physician identification of structures on ultrasound images is variable, and a relatively low Dice metric (0.34) correlated to a substantial agreement on subjective clinical assessment. We highlight the need to bring structure and clinical perspective to the evaluation of medical AI, which clinicians are best placed to direct.
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Affiliation(s)
- James S Bowness
- Nuffield Department of Clinical Anaesthesia, University of Oxford, Oxford, UK; Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK.
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pearse A Keane
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Bowness JS, James K, Yarlett L, Htyn M, Fisher E, Cassidy S, Morecroft M, Rees T, Noble JA, Higham H. Assistive artificial intelligence for enhanced patient access to ultrasound-guided regional anaesthesia. Br J Anaesth 2024; 132:1173-1175. [PMID: 37661562 DOI: 10.1016/j.bja.2023.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Affiliation(s)
- James S Bowness
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK; Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK.
| | - Kathryn James
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - Luke Yarlett
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - Marmar Htyn
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - Eluned Fisher
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - Simon Cassidy
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | | | - Tom Rees
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - J Alison Noble
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Helen Higham
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK; Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Dang D, Kamal M, Kumar M, Paliwal B, Nayyar A, Bhatia P, Singariya G. Comparison of human cadaver and blue phantom for teaching ultrasound-guided regional anesthesia to novice postgraduate students of anesthesiology: A randomized controlled trial. J Anaesthesiol Clin Pharmacol 2024; 40:276-282. [PMID: 38919433 PMCID: PMC11196044 DOI: 10.4103/joacp.joacp_234_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/18/2022] [Accepted: 10/19/2022] [Indexed: 06/27/2024] Open
Abstract
Background and Aims Simulation is increasingly used in medical teaching. Various studies have evaluated different simulation models for training of regional anesthesia (RA). We compared the use of human cadaver and blue phantom models for training of regional anesthesia to novice postgraduate students of anesthesiology. Material and Methods Fifty students were taught knobology of the ultrasonography (USG) machine. They were divided into two equal groups by computer-generated random number table, and the groups assigned were kept in sealed envelopes. In group BP, students were trained on a blue phantom model, and in group HC, students were trained on human cadaver. After training, a didactic video of sonoanatomy of the supraclavicular block was shown to all participants. The block performance was then judged on patients requiring supraclavicular block. The primary objective of the study was to compare the block performance time, and secondary objectives were the quality of image acquired, orientation of transducer to the target, identification of ultrasound artifacts, errors committed, complications, and success rate. Results The mean block performance time was shorter in group HC compared to group BP (451.96 ± 50.25 and 526.48 ± 43.486 s, respectively; P < 0.001). The image quality score, transducer orientation to the target, and identification of USG artifacts were better in group HC compared to group BP, with lesser number of needle passes. Conclusion Cadaver-based training produced better results compared to blue phantom simulator model for teaching of ultrasound-guided RA to novice postgraduate trainees of anesthesiology.
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Affiliation(s)
- Deepanshu Dang
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India
| | - Manoj Kamal
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India
| | | | - Bharat Paliwal
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India
| | - Ashish Nayyar
- Department of Anatomy, AIIMS, Jodhpur, Rajasthan, India
| | - Pradeep Bhatia
- Department of Anaesthesiology and Critical Care, AIIMS, Jodhpur, Rajasthan, India
| | - Geeta Singariya
- Department of Anaesthesiology, Dr S.N. Medical College, Jodhpur, Rajasthan, India
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Balavenkatasubramanian J, Kumar S, Sanjayan RD. Artificial intelligence in regional anaesthesia. Indian J Anaesth 2024; 68:100-104. [PMID: 38406349 PMCID: PMC10893813 DOI: 10.4103/ija.ija_1274_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 02/27/2024] Open
Abstract
Ultrasound-guided regional anaesthesia is used to facilitate the real-time performance of the regional block, increase the block success and reduce the complication rate. Artificial intelligence (AI) has been studied in many medical disciplines with high success rates, especially radiology. The purpose of this article was to review the evolution of AI in regional anaesthesia. The role of AI is to identify and optimise the sonography image, display the target, guide the practitioner to advance the needle tip to the intended target and inject the local anaesthetic. AI supports non-experts in training and clinical practice and experts in teaching ultrasound-guided regional anaesthesia.
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Affiliation(s)
- J Balavenkatasubramanian
- Senior Consultant and Academic Director, Ganga Medical Centre and Hospital Pvt Ltd, Coimbatore, Tamil Nadu, India
| | - Senthil Kumar
- Consultant Anaesthesiologist, Ganga Medical Centre and Hospital Pvt Ltd, Coimbatore, Tamil Nadu, India
| | - R. D. Sanjayan
- Department of Anaesthesia, Ganga Medical Centre and Hospital Pvt Ltd, Coimbatore, Tamil Nadu, India
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Ahmed GA, Wou F, Sharma RD, Narayanan M. Patient Satisfaction and Quality of Recovery With Ambulatory Serratus Plane Catheter After Mastectomy: A Service Evaluation. Cureus 2024; 16:e52588. [PMID: 38371118 PMCID: PMC10874676 DOI: 10.7759/cureus.52588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Background Acute moderate to severe pain after mastectomy is common and impedes patient recovery. Ambulatory serratus plane catheter with infusion pump (ASPIP) is a novel method to provide continuous delivery of local anaesthetic agents in the immediate postoperative period for extended analgesia, early mobility, and return to function after mastectomy. The aim of this project was to evaluate the introduction of ASPIP service and its effect on postoperative pain, opioid use, hospital stay, and recovery. Methods This was a service evaluation project. Eligible mastectomy patients were included over six months. All patients provided consent for intraoperative catheter insertion and ASPIP use. The numerical rating scale (NRS) and the Quality of Recovery-15 (QoR-15) tool were used to assess postoperative pain and the quality of recovery, respectively. Overall satisfaction, sleep quality, and recommendations for the catheter were collected. Day-case rates of mastectomy with or without reconstruction were also measured. Data were presented using descriptive statistics. Mean (SD) and median (quartiles) were used for the continuous variables with percentages to report rates. Approval of the institution's Audit & Quality Improvement Department was obtained. Results Thirty-two consecutive mastectomy patients were included over six months. The mean age was 60 years and the mean BMI was 25.8. Mean pain NRS (10 maximum) at rest and on movement were 1.88 vs. 2.56, 2.03 vs. 2.84, and 1.85 vs. 2.3 out of 10 on postoperative day (POD) one, two, and three, respectively. Six patients required opioids on POD one, four patients on POD two, and none on the third day. Sleep disturbance was observed in three, five, and three patients in the first three days, respectively. The mean overall satisfaction was 9.25/10 (SD: 1.18). All patients recommended ASPIP to other patients. QoR-15 scores reported as median (quartiles) were 143 (136, 147) preoperatively and 135 (126.5, 143) postoperatively, with a median difference of -3 (95% CI: -6 to 0). The day-case rate for mastectomy +/- reconstruction was 66% and 39%, respectively. There were no major complications from the catheter with minor issues in four patients. Conclusion The ASPIP is an effective and safe method of managing postoperative pain after mastectomy with positive patient experience and reduced opioid requirement. As part of an enhanced recovery pathway, it can also increase mastectomy day-case rates, including immediate implant reconstruction.
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Affiliation(s)
- Goran A Ahmed
- Breast Surgery, Frimley Health NHS Foundation Trust, Surrey, GBR
| | - Franklin Wou
- Anesthesiology and Critical Care, Guy's and St Thomas' NHS Foundation Trust, London, GBR
- Anesthesiology and Critical Care, Frimley Health NHS Foundation Trust, Surrey, GBR
| | - Rishabha D Sharma
- Breast Surgery, University Hospitals Plymouth NHS Trust, Plymouth, GBR
- Breast Surgery, Frimley Health NHS Foundation Trust, Surrey, GBR
| | - Madan Narayanan
- Anesthesiology and Critical Care, Frimley Health NHS Foundation Trust, Surrey, GBR
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Bowness JS, Morse R, Lewis O, Lloyd J, Burckett-St Laurent D, Bellew B, Macfarlane AJR, Pawa A, Taylor A, Noble JA, Higham H. Variability between human experts and artificial intelligence in identification of anatomical structures by ultrasound in regional anaesthesia: a framework for evaluation of assistive artificial intelligence. Br J Anaesth 2023; 132:S0007-0912(23)00542-1. [PMID: 39492288 PMCID: PMC11103080 DOI: 10.1016/j.bja.2023.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/25/2023] [Accepted: 09/19/2023] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND ScanNavTMAnatomy Peripheral Nerve Block (ScanNav™) is an artificial intelligence (AI)-based device that produces a colour overlay on real-time B-mode ultrasound to highlight key anatomical structures for regional anaesthesia. This study compares consistency of identification of sono-anatomical structures between expert ultrasonographers and ScanNav™. METHODS Nineteen experts in ultrasound-guided regional anaesthesia (UGRA) annotated 100 structures in 30 ultrasound videos across six anatomical regions. These annotations were compared with each other to produce a quantitative assessment of the level of agreement amongst human experts. The AI colour overlay was then compared with all expert annotations. Differences in human-human and human-AI agreement are presented for each structure class (artery, muscle, nerve, fascia/serosal plane) and structure. Clinical context is provided through subjective assessment data from UGRA experts. RESULTS For human-human and human-AI annotations, agreement was highest for arteries (mean Dice score 0.88/0.86), then muscles (0.80/0.77), and lowest for nerves (0.48/0.41). Wide discrepancy exists in consistency for different structures, both with human-human and human-AI comparisons; highest for sartorius muscle (0.91/0.92) and lowest for the radial nerve (0.21/0.27). CONCLUSIONS Human experts and the AI system both showed the same pattern of agreement in sono-anatomical structure identification. The clinical significance of the differences presented must be explored; however the perception that human expert opinion is uniform must be challenged. Elements of this assessment framework could be used for other devices to allow consistent evaluations that inform clinical training and practice. Anaesthetists should be actively engaged in the development and adoption of new AI technology.
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Affiliation(s)
- James S Bowness
- Nuffield Department of Clinical Anaesthesia, University of Oxford, Oxford, UK; Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK.
| | | | - Owen Lewis
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - James Lloyd
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | | | - Boyne Bellew
- Department of Surgery & Cancer, Imperial College London, London, UK; Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - Alan J R Macfarlane
- Department of Anaesthesia, NHS Greater Glasgow & Clyde, Glasgow, UK; School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | - Amit Pawa
- Department of Anaesthesia, Guy's & St Thomas' NHS Foundation Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - J Alison Noble
- Institute for Biomedical Engineering, University of Oxford, Oxford, UK
| | - Helen Higham
- Nuffield Department of Clinical Anaesthesia, University of Oxford, Oxford, UK; Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Xu FWX, Choo AMH, Ting PLM, Ong SJ, Khoo D. Leveraging AI in Postgraduate Medical Education for Rapid Skill Acquisition in Ultrasound-Guided Procedural Techniques. J Imaging 2023; 9:225. [PMID: 37888332 PMCID: PMC10607244 DOI: 10.3390/jimaging9100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
Ultrasound-guided techniques are increasingly prevalent and represent a gold standard of care. Skills such as needle visualisation, optimising the target image and directing the needle require deliberate practice. However, training opportunities remain limited by patient case load and safety considerations. Hence, there is a genuine and urgent need for trainees to attain accelerated skill acquisition in a time- and cost-efficient manner that minimises risk to patients. We propose a two-step solution: First, we have created an agar phantom model that simulates human tissue and structures like vessels and nerve bundles. Moreover, we have adopted deep learning techniques to provide trainees with live visualisation of target structures and automate assessment of their user speed and accuracy. Key structures like the needle tip, needle body, target blood vessels, and nerve bundles, are delineated in colour on the processed image, providing an opportunity for real-time guidance of needle positioning and target structure penetration. Quantitative feedback on user speed (time taken for target penetration), accuracy (penetration of correct target), and efficacy in needle positioning (percentage of frames where the full needle is visualised in a longitudinal plane) are also assessable using our model. Our program was able to demonstrate a sensitivity of 99.31%, specificity of 69.23%, accuracy of 91.33%, precision of 89.94%, recall of 99.31%, and F1 score of 0.94 in automated image labelling.
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Affiliation(s)
| | | | | | - Shao Jin Ong
- National University Hospital, National University Health Systems, Singapore 119074, Singapore; (F.W.X.X.); (A.M.H.C.); (P.L.M.T.); (D.K.)
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Harmon DJ, Boscardin CK, Cohen NH, Braehler MR. The efficacy of an anatomy and ultrasonography workshop on improving residents' confidence and knowledge in regional anesthesia. BMC MEDICAL EDUCATION 2023; 23:665. [PMID: 37710292 PMCID: PMC10500924 DOI: 10.1186/s12909-023-04653-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Ultrasound Guided Regional Anesthesia (UGRA) has become the standard for regional anesthesia practice, but there is not a standardized educational approach for training residents. The objective of this study was to evaluate the efficacy of an UGRA workshop utilizing the theoretical framework of embodied cognition for anesthesiology residents. METHODS A workshop was developed consisting of didactics, scanning training on standardized patients (SPs) and anatomy reviews on prosected cadavers that focused on the most common UGRA procedures for the upper and lower extremity. At the beginning of the workshop and at the end of the workshop residents completed pre-test and pre-confidence surveys, as well as post-test and post-confidence surveys, respectively to assess the impact of the workshop. RESULTS 39 residents (100% of the possible residents) participated in the workshop in 2019. Residents' confidence in identifying relevant anatomy for the most common UGRA procedures significantly increased in 13 of the 14 measurements. Residents' knowledge gain was also statistically significant from the pre-test to post-test (20.13 ± 3.61 and 26.13 ± 2.34; p < .0001). The residents found the course overall to be very useful (4.90 ± 0.38) and in particular the cadaveric component was highly rated (4.74 ± 0.55). CONCLUSIONS In this study, we developed a workshop guided by the embodied cognition framework to aid in shortening the overall learning curve of UGRA for anesthesiology residents. Based on our results this workshop should be replicated by institutions that are hoping to decrease the learning curve associated with UGRA and increase residents' confidence in identifying the relevant anatomy in UGRA nerve blocks.
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Affiliation(s)
- Derek J Harmon
- Division of Anatomy, Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, 320 W 10th Ave. B104 Starling Loving Hall, Columbus, OH, 43210, USA.
| | - Christy K Boscardin
- Department of Medicine and Anesthesia, University of California San Francisco, San Francisco, CA, USA
| | - Neal H Cohen
- Department of Anesthesia and Perioperative Care and Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Matthias R Braehler
- Department of Anesthesia and Perioperative Care and Medicine, University of California San Francisco, San Francisco, CA, USA
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13
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Jogie J, Jogie JA. A Comprehensive Review on the Efficacy of Nerve Blocks in Reducing Postoperative Anesthetic and Analgesic Requirements. Cureus 2023; 15:e38552. [PMID: 37273325 PMCID: PMC10239283 DOI: 10.7759/cureus.38552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2023] [Indexed: 06/06/2023] Open
Abstract
The purpose of this article review is to investigate whether or not nerve blocks are beneficial in minimizing the amount of postoperative anesthetic and analgesic medication required, hence improving patient outcomes and reducing healthcare costs. This review investigates several different kinds of nerve blocks, their administration techniques, and the anatomical and physiological aspects that influence nerve block effectiveness. It analyzes the impact of nerve blocks on opioid use, postoperative pain scores, and the incidence of opioid-related adverse effects by compiling the findings of numerous large-scale, randomized, controlled trials. Infection, hematoma, nerve injury, and systemic toxicity are some potential complications of nerve blocks discussed in the article. It concludes with recommendations for optimizing nerve block techniques in clinical practice and identifies areas that require further research, such as the development of new anesthetics and the identification of patient subgroups that would benefit the most from nerve blocks. In addition, it provides recommendations for optimizing nerve block techniques in clinical practice.
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Affiliation(s)
- Jason Jogie
- Anesthesiology, Port of Spain General Hospital, Port of Spain, TTO
| | - Joshua A Jogie
- Medicine, University of the West Indies, St. Augustine, TTO
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14
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Bowness JS, Burckett-St Laurent D, Hernandez N, Keane PA, Lobo C, Margetts S, Moka E, Pawa A, Rosenblatt M, Sleep N, Taylor A, Woodworth G, Vasalauskaite A, Noble JA, Higham H. Assistive artificial intelligence for ultrasound image interpretation in regional anaesthesia: an external validation study. Br J Anaesth 2023; 130:217-225. [PMID: 35987706 PMCID: PMC9900723 DOI: 10.1016/j.bja.2022.06.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/01/2022] [Accepted: 06/27/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Ultrasonound is used to identify anatomical structures during regional anaesthesia and to guide needle insertion and injection of local anaesthetic. ScanNav Anatomy Peripheral Nerve Block (Intelligent Ultrasound, Cardiff, UK) is an artificial intelligence-based device that produces a colour overlay on real-time B-mode ultrasound to highlight anatomical structures of interest. We evaluated the accuracy of the artificial-intelligence colour overlay and its perceived influence on risk of adverse events or block failure. METHODS Ultrasound-guided regional anaesthesia experts acquired 720 videos from 40 volunteers (across nine anatomical regions) without using the device. The artificial-intelligence colour overlay was subsequently applied. Three more experts independently reviewed each video (with the original unmodified video) to assess accuracy of the colour overlay in relation to key anatomical structures (true positive/negative and false positive/negative) and the potential for highlighting to modify perceived risk of adverse events (needle trauma to nerves, arteries, pleura, and peritoneum) or block failure. RESULTS The artificial-intelligence models identified the structure of interest in 93.5% of cases (1519/1624), with a false-negative rate of 3.0% (48/1624) and a false-positive rate of 3.5% (57/1624). Highlighting was judged to reduce the risk of unwanted needle trauma to nerves, arteries, pleura, and peritoneum in 62.9-86.4% of cases (302/480 to 345/400), and to increase the risk in 0.0-1.7% (0/160 to 8/480). Risk of block failure was reported to be reduced in 81.3% of scans (585/720) and to be increased in 1.8% (13/720). CONCLUSIONS Artificial intelligence-based devices can potentially aid image acquisition and interpretation in ultrasound-guided regional anaesthesia. Further studies are necessary to demonstrate their effectiveness in supporting training and clinical practice. CLINICAL TRIAL REGISTRATION NCT04906018.
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Affiliation(s)
- James S Bowness
- Oxford Simulation, Teaching and Research Centre, University of Oxford, Oxford, UK; Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK.
| | | | - Nadia Hernandez
- Department of Anesthesiology, Memorial Hermann Hospital, Texas Medical Centre, Houston, TX, USA
| | - Pearse A Keane
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK; National Institute for Health and Care Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Clara Lobo
- Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Eleni Moka
- Anaesthesiology Department, Creta InterClinic Hospital, Hellenic Healthcare Group, Heraklion, Crete, Greece
| | - Amit Pawa
- Department of Anaesthesia, Guy's and St Thomas' Hospitals NHS Trust, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Meg Rosenblatt
- Department of Anesthesiology, Perioperative and Pain Medicine, Mount Sinai Morningside and West Hospitals, New York, NY, USA
| | | | | | - Glenn Woodworth
- Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USA
| | | | - J Alison Noble
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Helen Higham
- Oxford Simulation, Teaching and Research Centre, University of Oxford, Oxford, UK; Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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15
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Bowness JS, Macfarlane AJ, Burckett-St Laurent D, Harris C, Margetts S, Morecroft M, Phillips D, Rees T, Sleep N, Vasalauskaite A, West S, Noble JA, Higham H. Evaluation of the impact of assistive artificial intelligence on ultrasound scanning for regional anaesthesia. Br J Anaesth 2023; 130:226-233. [PMID: 36088136 PMCID: PMC9900732 DOI: 10.1016/j.bja.2022.07.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/26/2022] [Accepted: 07/14/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Ultrasound-guided regional anaesthesia relies on the visualisation of key landmark, target, and safety structures on ultrasound. However, this can be challenging, particularly for inexperienced practitioners. Artificial intelligence (AI) is increasingly being applied to medical image interpretation, including ultrasound. In this exploratory study, we evaluated ultrasound scanning performance by non-experts in ultrasound-guided regional anaesthesia, with and without the use of an assistive AI device. METHODS Twenty-one anaesthetists, all non-experts in ultrasound-guided regional anaesthesia, underwent a standardised teaching session in ultrasound scanning for six peripheral nerve blocks. All then performed a scan for each block; half of the scans were performed with AI assistance and half without. Experts assessed acquisition of the correct block view and correct identification of sono-anatomical structures on each view. Participants reported scan confidence, experts provided a global rating score of scan performance, and scans were timed. RESULTS Experts assessed 126 ultrasound scans. Participants acquired the correct block view in 56/62 (90.3%) scans with the device compared with 47/62 (75.1%) without (P=0.031, two data points lost). Correct identification of sono-anatomical structures on the view was 188/212 (88.8%) with the device compared with 161/208 (77.4%) without (P=0.002). There was no significant overall difference in participant confidence, expert global performance score, or scan time. CONCLUSIONS Use of an assistive AI device was associated with improved ultrasound image acquisition and interpretation. Such technology holds potential to augment performance of ultrasound scanning for regional anaesthesia by non-experts, potentially expanding patient access to these techniques. CLINICAL TRIAL REGISTRATION NCT05156099.
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Affiliation(s)
- James S. Bowness
- Oxford Simulation, Teaching and Research Centre, University of Oxford, Oxford, UK,Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK,Corresponding author.
| | - Alan J.R. Macfarlane
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK,School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | | | - Catherine Harris
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | | | | | - David Phillips
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - Tom Rees
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | | | | | - Simeon West
- Department of Anaesthesia, University College London, London, UK
| | - J. Alison Noble
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Helen Higham
- Oxford Simulation, Teaching and Research Centre, University of Oxford, Oxford, UK,Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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16
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McConnell L, Bulman J. Liberal use of local anaesthetic and the risk of toxicity in elective arthroplasties at a tertiary teaching hospital. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221135307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Local anaesthetic systemic toxicity (LAST) is a life-threatening potential complication that may follow the administration of local anaesthetic (LA) drugs, and is cumulative across the drug class. Local anaesthetics are commonly administered via different routes for elective orthopaedic procedures – both by anaesthetists and surgeons. We hypothesized that total doses of LA may be routinely encroaching upon toxicity. Methods All total hip or knee arthroplasties (THAs and TKAs) performed within a 3 month period at the John Hunter Hospital (tertiary referral centre and teaching hospital) were audited to assess total administration of LA. Demographics, surgical characteristics, use of general anaesthesia or sedation, and use of local anaesthetic via any route of administration was recorded. For each patient, a weight-based theoretical maximum safe dose was calculated and compared against the dose they received. Data is presented as mean ± SD, percentages. Statistical significance was determined at p < 0.05. Results 130 THAs and TKAs were identified within the audit period. 52 patients exceeded their drug-class theoretical maximum safe dose. 49 patients exceeded their weight-based maximum dose for a single LA agent, in all cases ropivacaine. Non-obese individuals receive significantly higher mean dose than obese individuals (119.4% [98.6–140.3] vs 78.82% [65.95–91.69], p = 0.001). No LAST events were identified. Conclusions Patients who received elective total hip or knee arthroplasties were exposed to concerningly high total doses of local anaesthetic, suggesting that greater awareness of the additive toxicity of drugs within this class is required.
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Affiliation(s)
- Luke McConnell
- Department of Anaesthesia, John Hunter Hospital and University of Newcastle, Newcastle, New South Wales, Australia
| | - James Bulman
- JMO Unit, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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17
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Viderman D, Dossov M, Seitenov S, Lee MH. Artificial intelligence in ultrasound-guided regional anesthesia: A scoping review. Front Med (Lausanne) 2022; 9:994805. [PMID: 36388935 PMCID: PMC9640918 DOI: 10.3389/fmed.2022.994805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/22/2022] [Indexed: 01/06/2024] Open
Abstract
Background Regional anesthesia is increasingly used in acute postoperative pain management. Ultrasound has been used to facilitate the performance of the regional block, increase the percentage of successfully performed procedures and reduce the complication rate. Artificial intelligence (AI) has been studied in many medical disciplines with achieving high success, especially in radiology. The purpose of this review was to review the evidence on the application of artificial intelligence for optimization and interpretation of the sonographic image, and visualization of needle advancement and injection of local anesthetic. Methods To conduct this scoping review, we followed the PRISMA-S guidelines. We included studies if they met the following criteria: (1) Application of Artificial intelligence-assisted in ultrasound-guided regional anesthesia; (2) Any human subject (of any age), object (manikin), or animal; (3) Study design: prospective, retrospective, RCTs; (4) Any method of regional anesthesia (epidural, spinal anesthesia, peripheral nerves); (5) Any anatomical localization of regional anesthesia (any nerve or plexus) (6) Any methods of artificial intelligence; (7) Settings: Any healthcare settings (Medical centers, hospitals, clinics, laboratories. Results The systematic searches identified 78 citations. After the removal of the duplicates, 19 full-text articles were assessed; and 15 studies were eligible for inclusion in the review. Conclusions AI solutions might be useful in anatomical landmark identification, reducing or even avoiding possible complications. AI-guided solutions can improve the optimization and interpretation of the sonographic image, visualization of needle advancement, and injection of local anesthetic. AI-guided solutions might improve the training process in UGRA. Although significant progress has been made in the application of AI-guided UGRA, randomized control trials are still missing.
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Affiliation(s)
- Dmitriy Viderman
- Department of Biomedical Sciences, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
| | - Mukhit Dossov
- Department of Anesthesiology and Critical Care, Presidential Hospital, Nur-Sultan, Kazakhstan
| | - Serik Seitenov
- Department of Anesthesiology and Critical Care, Presidential Hospital, Nur-Sultan, Kazakhstan
| | - Min-Ho Lee
- Department of Computer Sciences, Nazarbayev University School of Engineering and Digital Sciences, Nur-Sultan, Kazakhstan
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18
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A modern roadmap for the use of simulation in regional anesthesiology training. Curr Opin Anaesthesiol 2022; 35:654-659. [PMID: 35942715 DOI: 10.1097/aco.0000000000001179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW A variety of educational modalities are used to teach regional anesthesia. Simulation is an educational tool that facilitates hands-on learning in a well tolerated, reproducible environment, eliminating potential harm to patients during the process of learning. Available literature and expert consensus statements support customizing simulation programs according to the level of training and experience of the learners. RECENT FINDINGS Simulation is useful for learners of all levels of expertise, though the application and frequency of simulation must be adapted to meet the learners' objectives. SUMMARY This review presents recommendations for the use of simulation for residents, fellows, practicing anesthesiologists without formal training in regional anesthesia, and practicing anesthesiologists with regional anesthesia expertise. Passports and portfolio programs that include simulation can be used to verify training. Virtual applications of simulation are growing, expanding the scope of regional anesthesia simulation and increasing access to lower resource areas.
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19
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Ashken T, Bowness J, Macfarlane AJR, Turbitt L, Bellew B, Bedforth N, Burckett-St Laurent D, Delbos A, El-Boghdadly K, Elkassabany NM, Ferry J, Fox B, French JLH, Grant C, Gupta A, Gupta RK, Gürkan Y, Haslam N, Higham H, Hogg RMG, Johnston DF, Kearns RJ, Lobo C, McKinlay S, Mariano ER, Memtsoudis S, Merjavy P, Narayanan M, Noble JA, Phillips D, Rosenblatt M, Sadler A, Sebastian MP, Schwenk ES, Taylor A, Thottungal A, Valdés-Vilches LF, Volk T, West S, Wolmarans M, Womack J, Pawa A. Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 2022; 47:762-772. [DOI: 10.1136/rapm-2022-103738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022]
Abstract
Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for “block view” (which visualizes the block site and is maintained for needle insertion/injection). A “strong recommendation” was made if ≥75% of participants rated any structure as “definitely include” in any round. A “weak recommendation” was made if >50% of participants rated it as “definitely include” or “probably include” for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a “strong recommendation” was made for 60 structures on orientation scanning and 44 on the block view. A “weak recommendation” was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.
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20
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Güven Aytaç B, Ünal Ş, Aytaç İ. A randomized, controlled simulation study comparing single and double operator ultrasound-guided regional nerve block techniques using a gelatine-based home-made phantom. Medicine (Baltimore) 2022; 101:e30368. [PMID: 36107586 PMCID: PMC9439790 DOI: 10.1097/md.0000000000030370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this study was to compare anesthesiology residents' acquisition of gripping and needling skills in either single-or double-operator ultrasound-guided nerve block using a hand-made phantom. DESIGN Prospective, randomized controlled study. METHODS After a tutorial session, 47 ultrasound-novice residents performed needling with double and single operator (Jedi, Bedforth, On-lock) grip techniques in each of the 3 interventional task sessions. RESULTS The time to perform the correct grip and needling decreased significantly between sessions for each technique (P < .001). While the double operator tasks required a shorter time than the single operator tasks in all 3 sessions (P < .001), there was no significant difference between the single-operator techniques. The number of needling attempts was similar between techniques and sessions. Participants rated the workload higher for the single-operator techniques on the National Aeronautics and Space Administration Task Load Index. CONCLUSION Hands-on training of phantom models may be beneficial for the acquisition of single-operator grip skills.
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Affiliation(s)
- Betül Güven Aytaç
- Department of Anesthesia, Health Science University, Ankara City Hospital, Ankara, Turkey
| | - Şeyma Ünal
- Department of Anesthesia, Health Science University, Ankara City Hospital, Ankara, Turkey
| | - İsmail Aytaç
- Department of Anesthesia, Health Science University, Ankara City Hospital, Ankara, Turkey
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21
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Olivares-Perez ME, Graglia S, Harmon DJ, Klein BA. Virtual anatomy and point-of-care ultrasonography integration pilot for medical students. ANATOMICAL SCIENCES EDUCATION 2022; 15:464-475. [PMID: 34748279 DOI: 10.1002/ase.2151] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 10/12/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
Despite its significant clinical use, there is no standardized point-of-care ultrasonography (POCUS) curriculum in undergraduate medical education. As Covid-19 abruptly mandated the use of virtual education, instructors were challenged to incorporate and improve POCUS education within these new constraints. It was hypothesized that integrating POCUS into anatomy via brief video lessons and a subsequent interactive virtual lesson would lead to an objective understanding of POCUS concepts, improved understanding of the corresponding anatomy, and subjective improvement of student confidence with POCUS. A cross-sectional descriptive study assessed first-year medical students' perspectives and performance before and after the interventions (n = 161). The intervention was split into two parts: (1) three optional 10-minute POCUS videos that reinforced anatomy concepts taught in the laboratory sessions, and (2) a subsequent two-hour interactive virtual session reviewing POCUS and anatomy concepts. Students completed a knowledge and confidence assessment tool before and after the interactive session. Survey responses (n = 51) indicated that 94% of students felt the optional videos improved their understanding of POCUS and were educationally valuable. One half of medical students (50%) indicated that the demonstrations improved their anatomy understanding. Initial self-reported confidence was low after the optional video lessons, despite an average score of 58% on the knowledge assessment (n = 130). However, confidence increased significantly along with an increase in score performance to 80% after the interactive session (n = 39, P < 0.01). Results suggest that the virtual integration pilot enhanced student learning of both anatomy and POCUS.
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Affiliation(s)
- Marcus E Olivares-Perez
- Department of Emergency Medicine, University of California, San Francisco-Fresno, Fresno, California, USA
| | - Sally Graglia
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA
| | - Derek J Harmon
- Department of Anatomy, University of California, San Francisco, School of Medicine, San Francisco, California, USA
| | - Barbie A Klein
- Department of Anatomy, University of California, San Francisco, School of Medicine, San Francisco, California, USA
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22
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Torrano V, Zadek F, Bugada D, Cappelleri G, Russo G, Tinti G, Giorgi A, Langer T, Fumagalli R. Simulation-Based Medical Education and Training Enhance Anesthesia Residents' Proficiency in Erector Spinae Plane Block. Front Med (Lausanne) 2022; 9:870372. [PMID: 35463012 PMCID: PMC9024057 DOI: 10.3389/fmed.2022.870372] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background Advances in regional anesthesia and pain management led to the advent of ultrasound-guided fascial plane blocks, which represent a new and promising route for the administration of local anesthetics. Both practical and theoretical knowledge of locoregional anesthesia are therefore becoming fundamental, requiring specific training programs for residents. Simulation-based medical education and training (SBET) has been recently applied to ultrasound-guided regional anesthesia (UGRA) with remarkable results. With this in mind, the anesthesia and intensive care residency program of the University of Milano-Bicocca organized a 4-h regional anesthesia training workshop with the BlockSim® (Accurate Srl, Cesena) simulator. Our study aimed to measure the residents' improvement in terms of reduction in time required to achieve an erector spinae plane (ESP) block. Methods Fifty-two first-year anesthesia residents were exposed to a 4-h training workshop focused on peripheral blocks. The course included an introductory theoretical session held by a locoregional anesthetist expert, a practical training on human models and mannequins using Onvision® (B. Braun, Milano) technologies, and two test performances on the BlockSim simulator. Residents were asked to perform two ESP blocks on the BlockSim: the first without previous practice on the simulator, the second at the end of the course. Trainees were also also asked to complete a self-assessment questionnaire. Results The time needed to achieve the block during the second attempt was significantly shorter (131 [83, 198] vs. 68 [27, 91] s, p < 0.001). We also observed a reduction in the number of needle insertions from 3 [2, 7] to 2 [1, 4] (p = 0.002), and an improvement aiming correctly at the ESP from 30 (58%) to 46 (88%) (p < 0.001). Forty-nine (94%) of the residents reported to have improved their regional anesthesia knowledge, 38 (73%) perceived an improvement in their technical skills and 46 (88%) of the trainees declared to be “satisfied/very satisfied” with the course. Conclusions A 4-h hands-on course based on SBET may enhance first-year residents' UGRA ability, decrease the number of punctures and time needed to perform the ESP block, and improve the correct aim of the fascia.
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Affiliation(s)
- Vito Torrano
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
| | - Francesco Zadek
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Dario Bugada
- Department of Emergency and Critical Care Medicine, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | | | - Gianluca Russo
- Department of Emergency and Urgency, Azienda Socio Sanitaria Territoriale Lodi, Lodi, Italy
| | - Giulia Tinti
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Antonio Giorgi
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Thomas Langer
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
- *Correspondence: Thomas Langer
| | - Roberto Fumagalli
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
- Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy
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23
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Erdem G, Ermiş Y, Özkan D. Peripheral nerve blocks and the use of artificial intelligence-assisted ultrasonography. J Clin Anesth 2021; 78:110597. [PMID: 34903443 DOI: 10.1016/j.jclinane.2021.110597] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Gökhan Erdem
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey.
| | - Yasemin Ermiş
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
| | - Derya Özkan
- University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Anesthesiology and Reanimation Clinic, Ankara, Turkey
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Matyal R, Fatima H, Mahmood F. Salvation Through Evolution. J Cardiothorac Vasc Anesth 2021; 35:3849-3850. [PMID: 34642045 DOI: 10.1053/j.jvca.2021.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Robina Matyal
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA.
| | - Huma Fatima
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
| | - Feroze Mahmood
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA
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25
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Bowness JS, Pawa A, Turbitt L, Bellew B, Bedforth N, Burckett-St Laurent D, Delbos A, Elkassabany N, Ferry J, Fox B, French JLH, Grant C, Gupta A, Harrop-Griffiths W, Haslam N, Higham H, Hogg R, Johnston DF, Kearns RJ, Kopp S, Lobo C, McKinlay S, Memtsoudis S, Merjavy P, Moka E, Narayanan M, Narouze S, Noble JA, Phillips D, Rosenblatt M, Sadler A, Sebastian MP, Taylor A, Thottungal A, Valdés-Vilches LF, Volk T, West S, Wolmarans M, Womack J, Macfarlane AJR. International consensus on anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 2021; 47:106-112. [PMID: 34552005 DOI: 10.1136/rapm-2021-103004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought through a modified Delphi process. A long-list of anatomical structures was refined through serial review by key opinion leaders in UGRA. All rounds were conducted remotely and anonymously to facilitate equal contribution of each participant. Blocks were considered twice in each round: for "orientation scanning" (the dynamic process of acquiring the final view) and for the "block view" (which visualizes the block site and is maintained for needle insertion/injection). Strong recommendations for inclusion were made if ≥75% of participants rated a structure as "definitely include" in any round. Weak recommendations were made if >50% of participants rated a structure as "definitely include" or "probably include" for all rounds (but the criterion for "strong recommendation" was never met). Thirty-six participants (94.7%) completed all rounds. 128 structures were reviewed; a "strong recommendation" is made for 35 structures on orientation scanning and 28 for the block view. A "weak recommendation" is made for 36 and 20 structures, respectively. This study provides recommendations on the core (minimum) set of anatomical structures to identify during ultrasound scanning for seven basic blocks in UGRA. They are intended to support consistent practice, empower non-experts using basic UGRA techniques, and standardize teaching and research.
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Affiliation(s)
- James Simeon Bowness
- OxSTaR, Oxford University, Oxford, UK .,Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
| | - Amit Pawa
- Department of Anaesthesia, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Boyne Bellew
- Department of Surgery & Cancer, Imperial College London, London, UK.,Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - Nigel Bedforth
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Alain Delbos
- Department of Anesthesia, Clinique Médipole Garonne, Toulouse, France
| | - Nabil Elkassabany
- Department of Anesthesiology & Intensive Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jenny Ferry
- Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
| | - Ben Fox
- Department of Anaesthesia, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, Norfolk, UK
| | - James L H French
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Calum Grant
- Department of Anaesthesia, NHS Tayside, Dundee, UK
| | - Ashwani Gupta
- Department of Anaesthesia, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | | | - Nat Haslam
- Department of Anaesthesia, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Helen Higham
- OxSTaR, Oxford University, Oxford, UK.,Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - David F Johnston
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Rachel Joyce Kearns
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.,Department of Anaesthesia, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sandra Kopp
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Clara Lobo
- Anestesiologista, Hospital das Forças Armadas Polo do Porto, Porto, Portugal
| | - Sonya McKinlay
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.,Department of Anaesthesia, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stavros Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Specialist Surgery, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Peter Merjavy
- Department of Anaesthesia, Craigavon Area Hospital, Portadown, UK
| | - Eleni Moka
- Department of Anaesthesiology, Hellenic Healthcare Group (HHG), Heraklion Crete, Greece
| | - Madan Narayanan
- Department of Anaesthesia, Frimley Park Hospital, Frimley, UK
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | | | - David Phillips
- Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
| | | | - Amy Sadler
- Department of Anaesthesia, NHS Tayside, Dundee, UK
| | - Maria Paz Sebastian
- Department of Anaesthetics, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - Athmaja Thottungal
- Department of Anaesthesia & Pain Management, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | | | - Thomas Volk
- Department of Anaesthesiology, Critical Care & Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Simeon West
- Department of Anaesthetics, University College London, London, UK
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Jonathan Womack
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Alan James Robert Macfarlane
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.,Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
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26
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Oliver-Fornies P, Ortega Lahuerta JP, Gomez Gomez R, Gonzalo Pellicer I, Herranz Andres P, Sancho-Saldana A. Postoperative neurological complications after brachial plexus block: a retrospective study conducted at a teaching hospital. J Anesth 2021; 35:844-853. [PMID: 34432155 DOI: 10.1007/s00540-021-02989-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/14/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Serious complications after ultrasound-guided regional anaesthesia can be devastating for the patient. The pathogenesis of postoperative neurological complications (PONC) is multifactorial and includes mechanical, vascular and chemical factors besides the nerve puncture itself. The primary aim of this study was to assess the incidence of PONC after brachial plexus block (BPB). METHODS This is an observational retrospective single-centre study conducted at the regional anaesthesia unit of a teaching hospital. All BPBs performed from January 2011 to November 2019 were included. The outcomes analysed were the incidence, aetiology and diagnosis of PONCs and the incidence of other postoperative complications such as local anaesthetic systemic toxicity (LAST), pneumothorax, wrong-side block, etc. The performance of trainees and experienced anaesthesiologists was compared across all the outcomes. RESULTS From a total of 5340 BPBs included, 15 cases developed PONC, yielding a rate of 2.81:1000 (95% CI 1.70-4.63). Thirteen patients underwent neurophysiological exams which confirmed nine neuropathies. The rate of PONCs for supervised trainees was 1.80:1000 (95% CI 0.701-4.62), not statistically different from that of experienced anaesthesiologists (p = 0.241). Three cases were considered to present with a PONC probably related to BPB [0.562:1,00 (95% CI 0.191-1.65)]. The incidence of long-term PONCs was 1.12:1000 (95% CI 0.515-2.45). Such complications proved irreversible in 2 cases. The incidences of LAST, pneumothorax and other complications observed were 0.749:1000 (95% CI 0.291-1.92), 0.187:1000 (95% CI 0.0331-1.06) and 4.31:1000 (95% CI 2.87-6.46), respectively. CONCLUSIONS This survey suggests that complications after ultrasound-guided BPB, including blocks performed by trainees, are uncommon. TRIAL REGISTRATION Clinicaltrials.gov ID: NCT04451642.
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Affiliation(s)
- Pablo Oliver-Fornies
- Department of Anesthesiology, Critical Care and Pain Medicine, Lozano Blesa University Clinical Hospital, Avda. San Juan Bosco, 15, 50009, Zaragoza, Spain.
- Investigator of GIIS083, Aragon Institute for Health Research (IISAragon), Zaragoza, Spain.
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain EchoTraining School, Madrid, Spain.
| | - Juan Pablo Ortega Lahuerta
- Division of Regional Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, Spain
| | - Roberto Gomez Gomez
- Division of Regional Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, Spain
| | - Inmaculada Gonzalo Pellicer
- Division of Regional Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, Spain
| | - Pilar Herranz Andres
- Division of Regional Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Miguel Servet University Hospital, Zaragoza, Spain
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27
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Cho NR, Cha JH, Park JJ, Kim YH, Ko DS. Reliability and Quality of YouTube Videos on Ultrasound-Guided Brachial Plexus Block: A Programmatical Review. Healthcare (Basel) 2021; 9:1083. [PMID: 34442220 PMCID: PMC8394722 DOI: 10.3390/healthcare9081083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Ultrasound-guided regional anesthesia has gained popularity over the last decade. This study aimed to assess whether YouTube videos sufficiently serve as an adjunctive tool for learning how to perform an ultrasound-guided brachial plexus block (BPB). METHODS All YouTube videos were classified, based on their sources, as either academic, manufacturer, educational, or individual videos. The metrics, accuracy, utility, reliability (using the Journal of American Medical Association Score benchmark criteria (JAMAS)), and educational quality (using the Global Quality Score (GQS) and Brachial Plexus Block Specific Quality Score (BSQS)) were validated. RESULTS Here, 175 videos were included. Academic (1.19 ± 0.62, mean ± standard deviation), manufacturer (1.17 ± 0.71), and educational videos (1.15 ± 0.76) had better JAMAS accuracy and reliability than individual videos (0.26 ± 0.67) (p < 0.001). Manufacturer (11.22 ± 1.63) and educational videos (10.33 ± 3.34) had a higher BSQS than individual videos (7.32 ± 4.20) (p < 0.001). All sources weakly addressed the equipment preparation and post-procedure questions after BSQS analysis. CONCLUSIONS The reliability and quality of ultrasound-guided BPB videos differ depending on their source. As YouTube is a useful educational platform for learners and teachers, global societies of regional anesthesiologists should set a standard for videos.
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Affiliation(s)
- Noo Ree Cho
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (N.R.C.); (J.H.C.)
| | - Jeong Ho Cha
- Department of Anesthesiology and Pain Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (N.R.C.); (J.H.C.)
| | - Jeong Jun Park
- Department of Anesthesiology and Pain Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam 13496, Korea;
| | - Yun Hak Kim
- Department of Biomedical Informatics, School of Medicine, Pusan National University, Yangsan 50612, Korea;
| | - Dai Sik Ko
- Division of Vascular Surgery, Department of Surgery, Gachon University Gil Medical Center, Incheon 21565, Korea
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28
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Gungor I, Gunaydin B, Oktar SO, M Buyukgebiz B, Bagcaz S, Ozdemir MG, Inan G. A real-time anatomy ıdentification via tool based on artificial ıntelligence for ultrasound-guided peripheral nerve block procedures: an accuracy study. J Anesth 2021; 35:591-594. [PMID: 34008072 PMCID: PMC8131172 DOI: 10.1007/s00540-021-02947-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 05/07/2021] [Indexed: 12/13/2022]
Abstract
We aimed to assess the accuracy of an artificial intelligence (AI)-based real-time anatomy identification software specifically developed to ease image interpretation intended for ultrasound-guided peripheral nerve block (UGPNB). Forty healthy participants (20 women, 20 men) were enrolled to perform interscalene, supraclavicular, infraclavicular, and transversus abdominis plane (TAP) blocks under ultrasound guidance using AI software by anesthesiology trainees. During block practice by a trainee, once the software indicates 100% scan success of each block associated anatomic landmarks, both raw and labeled ultrasound images were saved, assessed, and validated using a 5-point scale by expert validators. When trainees reached 100% scan success, accuracy scores of the validators were noted. Correlation analysis was used whether the relationship (r) according to demographics (gender, age, and body mass index: BMI) and block type exist. The BMI (kg/m2) and age (year) of participants were 22.2 ± 3 and 32.2 ± 5.25, respectively. Assessment scores of validators for all blocks were similar in male and female individuals. Mean assessment scores of validators were not significantly different according to age and BMI except for TAP block, which was inversely correlated with age and BMI (p = 0.01). AI technology can successfully interpret anatomical structures in real-time sonography while assisting young anesthesiologists during UGPNB practice.
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Affiliation(s)
- Irfan Gungor
- Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Berrin Gunaydin
- Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey.
| | - Suna O Oktar
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Beyza M Buyukgebiz
- Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Selin Bagcaz
- Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Miray Gozde Ozdemir
- Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
| | - Gozde Inan
- Department of Anesthesiology and Reanimation, Gazi University Faculty of Medicine, Besevler, 06500, Ankara, Turkey
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29
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Bowness J, Varsou O, Turbitt L, Burkett-St Laurent D. Identifying anatomical structures on ultrasound: assistive artificial intelligence in ultrasound-guided regional anesthesia. Clin Anat 2021; 34:802-809. [PMID: 33904628 DOI: 10.1002/ca.23742] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 12/29/2022]
Abstract
Ultrasound-guided regional anesthesia involves visualizing sono-anatomy to guide needle insertion and the perineural injection of local anesthetic. Anatomical knowledge and recognition of anatomical structures on ultrasound are known to be imperfect amongst anesthesiologists. This investigation evaluates the performance of an assistive artificial intelligence (AI) system in aiding the identification of anatomical structures on ultrasound. Three independent experts in regional anesthesia reviewed 40 ultrasound scans of seven body regions. Unmodified ultrasound videos were presented side-by-side with AI-highlighted ultrasound videos. Experts rated the overall system performance, ascertained whether highlighting helped identify specific anatomical structures, and provided opinion on whether it would help confirm the correct ultrasound view to a less experienced practitioner. Two hundred and seventy-five assessments were performed (five videos contained inadequate views); mean highlighting scores ranged from 7.87 to 8.69 (out of 10). The Kruskal-Wallis H-test showed a statistically significant difference in the overall performance rating (χ2 [6] = 36.719, asymptotic p < 0.001); regions containing a prominent vascular landmark ranked most highly. AI-highlighting was helpful in identifying specific anatomical structures in 1330/1334 cases (99.7%) and for confirming the correct ultrasound view in 273/275 scans (99.3%). These data demonstrate the clinical utility of an assistive AI system in aiding the identification of anatomical structures on ultrasound during ultrasound-guided regional anesthesia. Whilst further evaluation must follow, such technology may present an opportunity to enhance clinical practice and energize the important field of clinical anatomy amongst clinicians.
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Affiliation(s)
- James Bowness
- Oxford Simulation, Teaching and Research Centre, University of Oxford, Oxford, UK.,Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - Ourania Varsou
- Anatomy Facility, School of Life Sciences, University of Glasgow, Glasgow, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
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30
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Johnston DF, Turbitt LR. Defining success in regional anaesthesia. Anaesthesia 2021; 76 Suppl 1:40-52. [PMID: 33426663 DOI: 10.1111/anae.15275] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/13/2022]
Abstract
Utilisation of regional anaesthesia is increasing globally; however, it remains challenging to determine the overall benefit of individual regional anaesthesia procedures. Like any peri-operative intervention, the benefit to the patient and healthcare system must outweigh any patient risk or resource implications. This review aims to identify markers of success in regional anaesthesia, categorise these into an objective framework and rationalise suggestions on how measuring outcomes in regional anaesthesia can be used to develop the widespread performance of this evolving subspecialty. This framework of measuring success of regional anaesthesia contains four pillars: patient-centred, population-centred, healthcare-centred and training-centred outcomes. Each pillar of success contains several outcomes which provide a structure for the measurement and development of regional anaesthesia success on a global scale.
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Affiliation(s)
- D F Johnston
- Department of Anaesthesia, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - L R Turbitt
- Department of Anaesthesia, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, UK
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31
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Chin KJ, Mariano ER, El-Boghdadly K. Advancing towards the next frontier in regional anaesthesia. Anaesthesia 2021; 76 Suppl 1:3-7. [PMID: 33426654 DOI: 10.1111/anae.15321] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2020] [Indexed: 12/14/2022]
Affiliation(s)
- K J Chin
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - E R Mariano
- Department of Anesthesiology, Peri-operative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Anesthesiology and Peri-operative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.,King's College London, London, UK
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32
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Kumar V, Sirohiya P, Gupta N, Bharati SJ, Garg R, Mishra S. Effect of adding dexamethasone to ropivacaine for ultrasound-guided serratus anterior plane block in patients undergoing modified radical mastectomy: A preliminary trial. Indian J Anaesth 2020; 64:1032-1037. [PMID: 33542566 PMCID: PMC7852438 DOI: 10.4103/ija.ija_261_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/19/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Ultrasound-guided serratus anterior plane (SAP) block is a field block with high efficacy. We studied the analgesic effect of the addition of dexamethasone to ropivacaine in SAP block for modified radical mastectomy (MRM). METHODS Sixty patients undergoing MRM were randomised into two groups. Patients in Group P (n = 30) received 0.375% ropivacaine (0.4 ml/kg) with normal saline (2 ml) and those in group D (n = 30) received 0.375% ropivacaine (0.4 ml/kg) with 8 mg of dexamethasone (2 ml) in ultrasound-guided SAP block. The primary objective was to compare the time to first rescue analgesia and the secondary objectives were to compare the intraoperative fentanyl requirement, total diclofenac and tramadol requirements, and occurrence of nausea and vomiting in 24 hours, postoperatively. The statistical analysis was done using Mann-Whitney U-test, Chi-square test, Fisher's exact test, and Kaplan Meier survival estimates. RESULTS More patients required rescue analgesia in 24 hours in group P (33%) than group D (10%, P = 0.04). The probability of a pain free-period was significantly higher in group D than group P (P = 0.03, log-rank test). Intra-operative fentanyl requirement and postoperative diclofenac and tramadol requirements were comparable in both the groups. The incidence of postoperative nausea and vomiting was significantly more in Group P than Group D. CONCLUSION Addition of dexamethasone to ropivacaine for SAP block increases the time to first rescue analgesic in the postoperative period.
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Affiliation(s)
- Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
| | - Prashant Sirohiya
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute (Jhajjar), AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
| | - Sachidanand Jee Bharati
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA IRCH, AIIMS, New Delhi, India
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33
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Peripheral nerve blockade and novel analgesic modalities for ambulatory anesthesia. Curr Opin Anaesthesiol 2020; 33:760-767. [DOI: 10.1097/aco.0000000000000928] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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34
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Bowness J, El-Boghdadly K, Burckett-St Laurent D. Artificial intelligence for image interpretation in ultrasound-guided regional anaesthesia. Anaesthesia 2020; 76:602-607. [PMID: 32726498 DOI: 10.1111/anae.15212] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Affiliation(s)
- J Bowness
- Institute of Academic Anaesthesia, University of Dundee, Dundee, UK.,Department of Anaesthesia, Ninewells Hospital, Dundee, UK
| | - K El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's and St Thomas's NHS Foundation Trust, London, UK.,King's College London, London, UK
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35
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An D, Black ND, Tierney S, Chan VWS, Niazi AU. Impact of an ultrasound-guided regional anesthesia workshop on participants' confidence levels and clinical practice. Korean J Anesthesiol 2020; 73:465-467. [PMID: 32392671 PMCID: PMC7533181 DOI: 10.4097/kja.20203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Affiliation(s)
- Dong An
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Nicholas D Black
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Sarah Tierney
- Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Canada
| | - Vincent W S Chan
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Canada
| | - Ahtsham U Niazi
- Department of Anesthesia and Pain Management, Toronto Western Hospital, University of Toronto, Toronto, Canada
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36
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Ma IWY. Consensus-Based Expert Development of Critical Items for Direct Observation of Point-of-Care Ultrasound Skills. J Grad Med Educ 2020; 12:176-184. [PMID: 32322351 PMCID: PMC7161337 DOI: 10.4300/jgme-d-19-00531.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 12/11/2019] [Accepted: 12/31/2019] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is increasingly used in a number of medical specialties. To support competency-based POCUS education, workplace-based assessments are essential. OBJECTIVE We developed a consensus-based assessment tool for POCUS skills and determined which items are critical for competence. We then performed standards setting to set cut scores for the tool. METHODS Using a modified Delphi technique, 25 experts voted on 32 items over 3 rounds between August and December 2016. Consensus was defined as agreement by at least 80% of the experts. Twelve experts then performed 3 rounds of a standards setting procedure in March 2017 to establish cut scores. RESULTS Experts reached consensus for 31 items to include in the tool. Experts reached consensus that 16 of those items were critically important. A final cut score for the tool was established at 65.2% (SD 17.0%). Cut scores for critical items are significantly higher than those for noncritical items (76.5% ± SD 12.4% versus 53.1% ± SD 12.2%, P < .0001). CONCLUSIONS We reached consensus on a 31-item workplace-based assessment tool for identifying competence in POCUS. Of those items, 16 were considered critically important. Their importance is further supported by higher cut scores compared with noncritical items.
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Sonographic visibility of cannulas using convex ultrasound transducers. BIOMED ENG-BIOMED TE 2019; 64:691-698. [DOI: 10.1515/bmt-2018-0174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/30/2019] [Indexed: 11/15/2022]
Abstract
Abstract
The key for safe ultrasound (US)-guided punctures is a good visibility of the cannula. When using convex transducers for deep punctures, the incident angle between US beam and cannula varies along the cannula leading to a complex visibility pattern. Here, we present a method to systematically investigate the visibility throughout the US image. For this, different objective criteria were defined and applied to measurement series with varying puncture angles and depths of the cannula. It is shown that the visibility not only depends on the puncture angle but also on the location of the cannula in the US image when using convex transducers. In some image regions, an unexpected good visibility was observed even for steep puncture angles. The systematic evaluation of the cannula visibility is of fundamental interest to sensitise physicians to the handling of convex transducers and to evaluate new techniques for further improvement.
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Gallagher RM, Polomano RC, Giordano NA, Farrar JT, Guo W, Taylor L, Oslin D, Goff BJ, Buckenmaier CC. Prospective cohort study examining the use of regional anesthesia for early pain management after combat-related extremity injury. Reg Anesth Pain Med 2019:rapm-2019-100773. [PMID: 31563880 DOI: 10.1136/rapm-2019-100773] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/19/2019] [Accepted: 09/09/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND No studies have examined the long-term benefits of regional anesthesia (RA) for pain management after combat-related injury. The objective of this prospective cohort study was to examine the relationship between RA administration and patient-reported pain-related outcomes among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) service members sustaining a combat-related extremity injury. METHODS Between 2007 and 2013, n=358 American military personnel injured in OEF/OIF were enrolled at two military treatment facilities. Individuals were followed for up to 2 years after injury. Cohorts were defined based on whether participants were administered RA within 7 days after sustaining a combat-related injury, or not. Linear mixed effects models examined the association between RA and average pain intensity. Secondary outcomes included pain relief, pain interference, neuropathic pain symptoms, treatment outcomes related to pain management, and mental health symptoms. RESULTS Receiving early RA was associated with improved average pain over the first 6 months after injury (β=-0.57; p=0.012) adjusting for injury severity and length of stay at the primary treatment facility. This difference was observed up to 24 months after injury (β=-0.36; p=0.046). Individuals receiving early RA reported greater pain relief, improved neuropathic pain intensity, and higher satisfaction with pain outcomes; however, by 24 months, mean scores did not significantly differ between cohorts. CONCLUSION Findings indicate that when administered soon after traumatic injury, RA is a valuable pain management intervention. Future longitudinal studies investigating the timely delivery of RA for optimal pain management in civilian trauma settings are needed. TRIAL REGISTRATION NUMBER NCT00431847.
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Affiliation(s)
- Rollin M Gallagher
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
| | - Rosemary C Polomano
- Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Nicholas A Giordano
- Department of Military and Emergency Medicine, Uniformed Services University, Rockville, Maryland, USA
- Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland, USA
| | - John T Farrar
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Wensheng Guo
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lynn Taylor
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Oslin
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Behavioral Health Department, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, United States
| | - Brandon J Goff
- Department of Rehabilitation Medicine, United States Army Brooke Army Medical Center, Fort Sam Houston, Texas, USA
| | - Chester C Buckenmaier
- Department of Military and Emergency Medicine, Uniformed Services University, Rockville, Maryland, USA
- Defense and Veterans Center for Integrative Pain Management, Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland, USA
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Burnett GW, Shah AS, Katz DJ, Jeng CL. Survey of regional anesthesiology fellowship directors in the USA on the use of simulation in regional anesthesiology training. Reg Anesth Pain Med 2019; 44:rapm-2019-100719. [PMID: 31527159 DOI: 10.1136/rapm-2019-100719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/27/2019] [Accepted: 09/04/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite a growing interest in simulated learning, little is known about its use within regional anesthesia training programs. In this study, we aimed to characterise the simulation modalities and limitations of simulation use for US-based resident and fellow training in regional anesthesiology. METHODS An 18-question survey was distributed to regional anesthesiology fellowship program directors in the USA. The survey aimed to describe residency and fellowship program demographics, modalities of simulation used, use of simulation for assessment, and limitations to simulation use. RESULTS Forty-two of 77 (54.5%) fellowship directors responded to the survey. Eighty per cent of respondents with residency training programs utilized simulation for regional anesthesiology education, while simulation was used for 66.7% of fellowship programs. The most common modalities of simulation were gel phantom models (residency: 80.0%, fellowship: 52.4%) and live model scanning (residency: 50.0%, fellowship: 42.9%). Only 12.5% of residency programs and 7.1% of fellowship programs utilized simulation for assessment of skills. The most common greatest limitation to simulation use was simulator availability (28.6%) and funding (21.4%). CONCLUSIONS Simulation use for education is common within regional anesthesiology training programs, but rarely used for assessment. Funding and simulator availability are the most common limitations to simulation use.
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Affiliation(s)
- Garrett W Burnett
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Anjan S Shah
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Daniel J Katz
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Christina L Jeng
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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The road to accreditation for fellowship training in regional anesthesiology and acute pain medicine. Curr Opin Anaesthesiol 2018; 31:643-648. [DOI: 10.1097/aco.0000000000000639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rahimzadeh P, Imani F, Faiz SHR, Boroujeni BV. Impact of the Ultrasound-Guided Serratus Anterior Plane Block on Post-Mastectomy Pain: A Randomised Clinical Study. Turk J Anaesthesiol Reanim 2018; 46:388-392. [PMID: 30263863 PMCID: PMC6157977 DOI: 10.5152/tjar.2018.86719] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/19/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE A variety of methods, including neuraxial and regional blocks, have been used to manage post-mastectomy pain. This study evaluates the effect of serratus anterior plane block on acute pain after mastectomy. METHODS A total of 60 patients who were candidates for mastectomy under general anaesthesia were divided in this trial into two groups. After entering the recovery room, the first-experimental-group (SAB) underwent the ultrasound-guided serratus anterior block, but the second-control-group (CTL) received no block intervention. An intravenous patient-controlled analgesia (PCA) device was used to deliver fentanyl in both groups. Using the Visual Analog Scale (VAS), the patients' pain was assessed at intervals of 1, 6, 12 and 24 hours after entering the recovery room. Intravenous acetaminophen was administered as a rescue analgesic if the pain exceeded 3 on the VAS. A total amount of fentanyl consumed, the time to first PCA request, a total amount of acetaminophen consumption and possible adverse effects were evaluated. RESULTS The pain scores assessed at the time intervals were not significantly different between the two groups (p>0.5). The total consumption of fentanyl was significantly lower in the SAB group than in the CTL group (p=0.0001). Duration of the time to first PCA request was remarkably longer in the SAB group than in the CTL group (p=0.0001). The total amount of acetaminophen consumed was notably higher in the CTL group than in the SAB group (p=0.001). None of the patients experienced side effects. CONCLUSION Undertaking serratus anterior block following mastectomy can reduce pain scores and lower opioid usage.
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Affiliation(s)
- Poupak Rahimzadeh
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farnad Imani
- Pain Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Hamid Reza Faiz
- Rasoul Akram Hospital Clinical Research Development Center, Iran University of Medical Sciences, Tehran, Iran
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Efficacy of different multimodal analgesia techniques to prevent moderate to severe pain in primary total knee arthroplasty. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2018. [DOI: 10.1097/cj9.0000000000000039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Borg LK, Harrison TK, Kou A, Mariano ER, Udani AD, Kim TE, Shum C, Howard SK. Preliminary Experience Using Eye-Tracking Technology to Differentiate Novice and Expert Image Interpretation for Ultrasound-Guided Regional Anesthesia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:329-336. [PMID: 28777464 DOI: 10.1002/jum.14334] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 04/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Objective measures are needed to guide the novice's pathway to expertise. Within and outside medicine, eye tracking has been used for both training and assessment. We designed this study to test the hypothesis that eye tracking may differentiate novices from experts in static image interpretation for ultrasound (US)-guided regional anesthesia. METHODS We recruited novice anesthesiology residents and regional anesthesiology experts. Participants wore eye-tracking glasses, were shown 5 sonograms of US-guided regional anesthesia, and were asked a series of anatomy-based questions related to each image while their eye movements were recorded. The answer to each question was a location on the sonogram, defined as the area of interest (AOI). The primary outcome was the total gaze time in the AOI (seconds). Secondary outcomes were the total gaze time outside the AOI (seconds), total time to answer (seconds), and time to first fixation on the AOI (seconds). RESULTS Five novices and 5 experts completed the study. Although the gaze time (mean ± SD) in the AOI was not different between groups (7 ± 4 seconds for novices and 7 ± 3 seconds for experts; P = .150), the gaze time outside the AOI was greater for novices (75 ± 18 versus 44 ± 4 seconds for experts; P = .005). The total time to answer and total time to first fixation in the AOI were both shorter for experts. CONCLUSIONS Experts in US-guided regional anesthesia take less time to identify sonoanatomy and spend less unfocused time away from a target compared to novices. Eye tracking is a potentially useful tool to differentiate novices from experts in the domain of US image interpretation.
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Affiliation(s)
- Lindsay K Borg
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - T Kyle Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Alex Kou
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Edward R Mariano
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Ankeet D Udani
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - T Edward Kim
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Cynthia Shum
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Steven K Howard
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
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Bustamante S, Cheruku S. Ultrasound to Improve Target Site Identification for Proximal Humerus Intraosseous Vascular Access. Anesth Analg 2018; 123:1335-1337. [PMID: 27575561 DOI: 10.1213/ane.0000000000001543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Sergio Bustamante
- Department of Cardiothoracic Anesthesiology The Cleveland Clinic Foundation, Cleveland, Ohio,
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45
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Kaushal A, Bindra A, Singh S. Mobile phone holder as an ultrasound transducer stabilisation device: A novel technique. Indian J Anaesth 2018; 62:635-636. [PMID: 30166662 PMCID: PMC6100279 DOI: 10.4103/ija.ija_375_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ashutosh Kaushal
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Shalendra Singh
- Department of Anaesthesiology, AFMC, Pune, Maharashtra, India
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Ultrasound Detection of Arteria Comitans: A Novel Technique to Locate the Sciatic Nerve. Reg Anesth Pain Med 2017; 43:57-61. [PMID: 29035937 DOI: 10.1097/aap.0000000000000665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the gluteal and thigh region, the arteria comitans accompanies the sciatic nerve for a short distance, then penetrates the nerve and runs to the lower part of the thigh. There is no study that recognizes this artery as a guide to the location of the sciatic nerve. In this report, we describe a series of 6 knee arthroplasty patients in whom ultrasound-guided sciatic nerve block was successfully performed using color Doppler and pulsed wave Doppler to visualize the arteria comitans as a guide to the location of the sciatic nerve. We have found that detecting the arteria comitans as a landmark is novel and may offer an additional tool with the existing methods for sciatic nerve block.
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Das Adhikary S, Karanzalis D, Liu WMR, Hadzic A, McQuillan PM. A Prospective Randomized Study to Evaluate a New Learning Tool for Ultrasound-Guided Regional Anesthesia. PAIN MEDICINE 2017; 18:856-865. [PMID: 28034969 DOI: 10.1093/pm/pnw287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective To evaluate the effectiveness of a new learning tool for needle insertion accuracy skills during a simulated ultrasound-guided regional anesthesia procedure. Methods Thirty participants were included in this randomized controlled study. After viewing a prerecorded video of a single, discreet, ultrasound-guided regional anesthesia task, all participants performed the same task three consecutive times (pretest), and needle insertion accuracy skills in a phantom model were recorded as baseline. All participants were then randomized into two groups, experimental and control. The experimental group practiced the task using the new tool, designed with two video cameras, a monitor, and an ultrasound machine where the images from the ultrasound and video of hand movements are viewed simultaneously on the monitor. The control group practiced the task without using the new tool. After the practice session, both groups repeated the same task and were evaluated in the same manner as in the pretest. Results Participants in both group groups had similar baseline characteristics with respect to previous experience with ultrasound-guided regional anesthesia procedures. The experimental group had significantly better needle insertion accuracy scores ( P < 0.01) than the control group. Using the new learning tool, inexperienced participants had better needle insertion accuracy scores ( P < 0.01) compared with experienced participants. Conclusions This study demonstrates that the use of this new learning tool results in short-term improvement in hand-eye, motor, and basic needle insertion skills during a simulated ultrasound-guided regional anesthesia procedure vs traditional practice methods. Skill improvement was greater in novices compared with experienced participants.
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Affiliation(s)
- Sanjib Das Adhikary
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Demetrius Karanzalis
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Wai-Man Raymond Liu
- Research School of Finance, Actuarial Studies and Applied Statistics, The Australian National University, Acton, Australia
| | - Admir Hadzic
- Department of Anesthesia, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Patrick M McQuillan
- Department of Anesthesiology and Perioperative Medicine, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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So S, Patel RM, Orebaugh SL. Ultrasound imaging in medical student education: Impact on learning anatomy and physical diagnosis. ANATOMICAL SCIENCES EDUCATION 2017; 10:176-189. [PMID: 27286419 DOI: 10.1002/ase.1630] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 05/18/2016] [Accepted: 05/18/2016] [Indexed: 05/28/2023]
Abstract
Ultrasound use has expanded dramatically among the medical specialties for diagnostic and interventional purposes, due to its affordability, portability, and practicality. This imaging modality, which permits real-time visualization of anatomic structures and relationships in vivo, holds potential for pre-clinical instruction of students in anatomy and physical diagnosis, as well as providing a bridge to the eventual use of bedside ultrasound by clinicians to assess patients and guide invasive procedures. In many studies, but not all, improved understanding of anatomy has been demonstrated, and in others, improved accuracy in selected aspects of physical diagnosis is evident. Most students have expressed a highly favorable impression of this technology for anatomy education when surveyed. Logistic issues or obstacles to the integration of ultrasound imaging into anatomy teaching appear to be readily overcome. The enthusiasm of students and anatomists for teaching with ultrasound has led to widespread implementation of ultrasound-based teaching initiatives in medical schools the world over, including some with integration throughout the entire curriculum; a trend that likely will continue to grow. Anat Sci Educ 10: 176-189. © 2016 American Association of Anatomists.
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Affiliation(s)
- Sokpoleak So
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Rita M Patel
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven L Orebaugh
- Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Sawhney C, Lalwani S, Ray BR, Sinha S, Kumar A. Benefits and Pitfalls of Cadavers as Learning Tool for Ultrasound-guided Regional Anesthesia. Anesth Essays Res 2017; 11:3-6. [PMID: 28298747 PMCID: PMC5341665 DOI: 10.4103/0259-1162.186607] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Ultrasound-guided regional anesthesia (UGRA), like other basic skills, should be learnt in a simulation laboratory before performing on the patient. Cadavers provide an ideal tool for learning sonoanatomy and skills required for performing UGRA. On the basis of preservation technique used, the cadavers can be formalin embalmed cadavers, Thiel cadavers (soft cadavers), and fresh frozen cadavers. We compared three types of cadavers for performing ultrasound-guided upper and lower limb blocks. We observed that fresh frozen and Thiel cadavers were less smelling and had more realistic appearance as compared to formalin embalmed cadavers. It was seen that Thiel cadavers were more flexible and hence, rotation of neck, shoulder and knee was easier. Although images seen in most cadavers were comparable with live subjects but, Thiel cadavers provided more realistic model.
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Affiliation(s)
- Chhavi Sawhney
- Department of Anesthesia, Pain Medicine and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Lalwani
- Department of Forensic Medicine, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Bikash Ranjan Ray
- Department of Anesthesia, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Sinha
- Department of Neurosugery, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Abhyuday Kumar
- Department of Anesthesia, Pain Medicine and Critical Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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