Torrano Vito, Zadek Francesco, Bugada Dario, Cappelleri Gianluca, Russo Gianluca, Tinti Giulia, Giorgi Antonio, Langer Thomas, Fumagalli Roberto
Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy.
Front Med (Lausanne). 2022 Apr 8;9:870372. doi: 10.3389/fmed.2022.870372. eCollection 2022.
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.
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.
The time needed to achieve the block during the second attempt was significantly shorter (131 [83, 198] vs. 68 [27, 91] s, < 0.001). We also observed a reduction in the number of needle insertions from 3 [2, 7] to 2 [1, 4] ( = 0.002), and an improvement aiming correctly at the ESP from 30 (58%) to 46 (88%) ( < 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.
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.
区域麻醉和疼痛管理的进展促使超声引导筋膜平面阻滞问世，这是一种新的、有前景的局部麻醉药给药途径。因此，局部区域麻醉的实践和理论知识正变得至关重要，这需要为住院医师制定特定的培训计划。基于模拟的医学教育与培训（SBET）最近已应用于超声引导区域麻醉（UGRA），并取得了显著成果。考虑到这一点，米兰比可卡大学的麻醉与重症监护住院医师培训项目组织了一次为期4小时的区域麻醉培训工作坊，使用BlockSim（Accurate Srl，切塞纳）模拟器。我们的研究旨在衡量住院医师在减少完成竖脊肌平面（ESP）阻滞所需时间方面的进步。
52名一年级麻醉住院医师参加了一个为期4小时、专注于外周阻滞的培训工作坊。课程包括由局部区域麻醉专家进行的理论入门讲座、使用Onvision（贝朗医疗，米兰）技术在人体模型和模拟人上进行的实践培训，以及在BlockSim模拟器上进行的两次测试操作。要求住院医师在BlockSim上进行两次ESP阻滞：第一次是在未事先在模拟器上练习的情况下，第二次是在课程结束时。还要求学员完成一份自我评估问卷。
第二次尝试时完成阻滞所需的时间显著缩短（131 [83, 198] 秒 vs. 68 [27, 91] 秒，< 0.001）。我们还观察到进针次数从3 [2, 7] 次减少到2 [1, 4] 次（ = 0.002），正确对准ESP的成功率从30次（58%）提高到46次（88%）（ < 0.001）。49名（94%）住院医师报告称他们的区域麻醉知识有所提高，38名（73%）感觉自己的技术技能有所提高，46名（88%）学员表示对该课程“满意/非常满意”。
基于SBET的4小时实践课程可能会提高一年级住院医师的UGRA能力，减少穿刺次数和进行ESP阻滞所需的时间，并提高对筋膜的正确瞄准。
