From the Department of Pediatric Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Simul Healthc. 2013 Dec;8(6):368-75. doi: 10.1097/SIH.0b013e318299dae2.
Ultrasound-guided regional anesthesia (UGRA) skills are traditionally obtained by supervised performance on patients, but practice on phantom models improves success. Currently available models are expensive or use perishable products, for example, olive-in-chicken breasts (OCB). We constructed 2 inexpensive phantom (transparent and opaque) models with readily available nonperishable products and compared the process of learning UGRA skills by novice practitioners on these models with the OCB model.
Three experts first established criteria for a satisfactory completion of the simulated UGRA task in the 3 models. Thirty-six novice trainees (<20 previous UGRA experience) were randomly assigned to perform a UGRA task on 1 of 3 models-the transparent, opaque, and OCB models, where the hyperechoic target was identified, a needle was advanced to it under ultrasound guidance, fluid was injected, and images were saved. We recorded the errors during task completion, number of attempts and needle passes, and the time for target identification and needle placement until the predetermined benchmark of 3 consecutive successful UGRA simulations was accomplished.
The number of errors, needle passes, and time for task completion per attempt progressively decreased in all 3 groups. However, failure to identify the target and to visualize the needle on the ultrasound image occurred more frequently with the OCB model. The time to complete simulator training was shortest with the transparent model, owing to shorter target identification times. However, trainees were less likely to agree strongly that this model was realistic for teaching UGRA skills.
Training on inexpensive synthetic simulation models with no perishable products permits learning of UGRA skills by novices. The OCB model has disadvantages of containing potentially infective material, requires refrigeration, cannot be used after multiple needle punctures, and is associated with more failures during simulated UGRA. Direct visualization of the target in the transparent model allows the trainee to focus on needle insertion skills, but the opaque model may be more realistic for learning target identification skills required when UGRA is performed on real patients in the operating room.
超声引导区域麻醉（UGRA）技能传统上是通过在患者身上进行监督操作来获得的，但在幻影模型上进行练习可以提高成功率。目前可用的模型价格昂贵或使用易腐产品，例如，鸡胸中的橄榄（OCB）。我们使用现成的非易腐产品构建了 2 个廉价的幻影（透明和不透明）模型，并将新手从业者在这些模型上学习 UGRA 技能的过程与 OCB 模型进行了比较。
三位专家首先在 3 种模型中为模拟 UGRA 任务的满意完成确立了标准。36 名新手学员（<20 次以前的 UGRA 经验）被随机分配到 3 种模型中的 1 种模型上进行 UGRA 任务，透明、不透明和 OCB 模型，在那里识别出高回声目标，在超声引导下将针推进目标，注入流体，并保存图像。我们记录了任务完成过程中的错误、尝试次数和针数，以及识别目标和放置针的时间，直到完成预定的 3 次连续成功 UGRA 模拟的基准。
在所有 3 个组中，每次尝试的错误、针数和任务完成时间都逐渐减少。然而，在 OCB 模型中，目标识别和超声图像上的针可视化更频繁地失败。由于目标识别时间较短，透明模型完成模拟器培训的时间最短。然而，学员不太可能强烈认为这个模型对于教授 UGRA 技能是现实的。
使用无易腐产品的廉价合成模拟模型进行培训可以使新手学员学习 UGRA 技能。OCB 模型存在潜在感染性物质、需要冷藏、多次针穿刺后无法使用以及在模拟 UGRA 中失败较多的缺点。在透明模型中直接观察目标可以使学员专注于针插入技能，但不透明模型对于学习在手术室对真实患者进行 UGRA 时所需的目标识别技能可能更为现实。
