Grant Ashley, Sullivan Colin, Buchel Brandon, Derr Charlotte
Emergency Medicine, Florida State University College of Medicine, Sarasota, USA.
Emergency Medicine, St Joseph's Hospital - South, Riverview, USA.
Cureus. 2025 Jan 2;17(1):e76807. doi: 10.7759/cureus.76807. eCollection 2025 Jan.
Introduction Ultrasound guidance for the delivery of regional anesthesia in the emergency department (ED) is an area of increasing interest. However, in order to perform a regional nerve block, one must first be able to correctly identify the specific nerve on ultrasound. Therefore, the primary purpose of this study is to investigate the number of supervised ultrasound examinations required for an emergency medicine (ED) physician to gain proficiency in accurately identifying the nerves of the lower extremity at the level of the femoral and popliteal nerves. Methods The proficiency outcome was defined as the number of attempts a resident needed to locate and correctly identify the femoral and popliteal nerves for 10 consecutive examinations. Didactic education was provided via a one-hour lecture and two supervised hands-on ultrasound examinations for each region prior to testing. Count data are summarized using percentages or medians and ranges. Random effects negative binomial regression was used for modeling panel count data, with the results summarized as an incidence rate ratio (95% confidence interval) and P-values <0.05 considered statistically significant. Results Complete data for the number of attempts, confidence, gender, and years in practice was available for 31 residents. The median number of attempts and range for popliteal and femoral nerves were 0 (0-11) and 0 (0-11), respectively. The median level of confidence and range for popliteal and femoral nerves were 3.5 (1-5) and 3 (1-5), respectively. There was a significant association between confidence and proficiency (P=0.009) and between years in practice and proficiency (P=0.010). Conclusion The findings of this small data set would suggest that proficiency can be quickly obtained in identifying the femoral and popliteal nerves with ultrasound after only a few proctored examinations. A significant association was found between years in practice and proficiency. This suggests that physicians with previous ultrasound scanning experience may require fewer supervised examinations when learning how to identify the femoral and popliteal nerves.
引言 急诊科（ED）区域麻醉的超声引导是一个越来越受关注的领域。然而，为了实施区域神经阻滞，首先必须能够在超声下正确识别特定神经。因此，本研究的主要目的是调查急诊医学（ED）医生在获得熟练准确识别股神经和腘神经水平下肢神经的能力之前所需的超声检查监督次数。
方法 熟练程度的结果定义为住院医师在连续10次检查中定位并正确识别股神经和腘神经所需的尝试次数。在测试前，通过一小时的讲座和每个区域两次有监督的实践超声检查提供教学教育。计数数据使用百分比、中位数和范围进行总结。随机效应负二项回归用于对面板计数数据进行建模，结果总结为发病率比（95%置信区间），P值<0.05被认为具有统计学意义。
结果 31名住院医师提供了关于尝试次数、信心、性别和执业年限的完整数据。腘神经和股神经的尝试次数中位数及范围分别为0（0-11）和0（0-11）。腘神经和股神经的信心水平中位数及范围分别为3.5（1-5）和3（1-5）。信心与熟练程度之间（P=0.009）以及执业年限与熟练程度之间（P=0.010）存在显著关联。
结论 这个小数据集的结果表明，仅经过几次有监督的检查后，就能快速获得用超声识别股神经和腘神经的熟练程度。发现执业年限与熟练程度之间存在显著关联。这表明有超声扫描经验的医生在学习如何识别股神经和腘神经时可能需要更少的监督检查。
