Pain Management Department, Hospital Zambrano Hellion, Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, San Pedro Garza García, México.
Pain Pract. 2021 Nov;21(8):984-990. doi: 10.1111/papr.13026. Epub 2021 Jun 17.
Fluoroscopic-guided lumbar procedures have increased in daily pain practice because the lumbar spine is one of the most common sources of pain. Interventional pain fellows must develop a minimum number of skills during their training in order to achieve the competences without neglecting radiological safety. However, medical training in fluoroscopic-guided interventions is being affected by the current coronavirus disease 2019 (COVID-19) situation.
The objective of this study was to evaluate the use of a phantom model for lumbar injection as a training strategy during the COVID-19 pandemic in fellows of interventional pain. The study was divided into theoretical and practical modules. The hands-on practice was performed in a lumbar model phantom where fellows were evaluated in four fluoroscopically guided approaches: intra-articular facet block (IAFB), medial branch block (MBB), transforaminal block (TFB), and interlaminar block (ILB) divided in 5 sessions. The aim was to make as many punctures as possible in every session. We measured total procedural performance (TPP), total needle hand time (TNH), and total radiation dose generated by the fluoroscopic machine (TRD) during each procedure. Additionally, a survey was applied to evaluate confidence and satisfaction before and after training.
A total of 320 lumbar punctures were completed. The results were statistically significant in all approaches attempted (p < 0.01). The fellow's survey for satisfaction and confidence demonstrated a significant difference between pre and post-test (p < 0.01).
The results of this study highlight the importance of adaptations and adoption of new educational models. The use of the phantom model for simulation could be a strategy for other emerging situations, like the COVID-19 pandemic. Including this practice in the interventional pain programs could lead to better results for the patient and operator radiology safety.
由于腰椎是最常见的疼痛源之一，因此在日常疼痛实践中，荧光镜引导的腰椎程序有所增加。介入性疼痛研究员在培训过程中必须发展出最低数量的技能，以便在不忽视放射学安全性的情况下实现这些技能。然而，由于当前的 2019 年冠状病毒病（COVID-19）情况，荧光镜引导介入治疗的医学培训受到了影响。
本研究的目的是评估在 COVID-19 大流行期间，使用腰椎注射模型作为介入性疼痛研究员培训策略的效果。该研究分为理论和实践两个模块。实际操作是在腰椎模型模型上进行的，研究员在四个荧光镜引导的方法中进行了评估：关节内关节突阻滞（IAFB），内侧支阻滞（MBB），经椎间孔阻滞（TFB）和椎间层阻滞（ILB），分为 5 个会话。目的是在每个会话中尽可能多地进行穿刺。我们测量了每个程序的总程序性能（TPP），总针手时间（TNH）和荧光机产生的总辐射剂量（TRD）。此外，在培训前后进行了一项调查，以评估信心和满意度。
总共完成了 320 次腰椎穿刺。所有尝试的方法均具有统计学意义（p <0.01）。研究员的满意度和信心调查显示，前后测试之间存在显着差异（p <0.01）。
这项研究的结果强调了适应和采用新的教育模式的重要性。模拟使用幻影模型可能是其他新兴情况（例如 COVID-19 大流行）的策略。将这种实践纳入介入性疼痛计划可以为患者和操作人员的放射学安全带来更好的结果。
