Kopacz D J, Neal J M, Pollock J E
Department of Anesthesiology, Virginia Mason Clinic, Seattle, Washington 98111, USA.
Reg Anesth. 1996 May-Jun;21(3):182-90.
Wide variability exists in the amount of regional anesthesia practice to which residents are exposed during training. The number of attempts at various blocks before a trainee becomes proficient at performing these regional anesthetic techniques is not known. This study addresses the question: What is the minimum number of blocks a resident must perform to reach consistency during training in these techniques?
Every regional anesthetic technique attempted by all beginning CA-1 anesthesiology residents (n = 7) during their first 6 months of training (July 1993 to December 1993) were recorded on a daily basis. Nonregional anesthetic techniques attempted were recorded for comparison. The objective measures used to define the degree of success were obtaining cerebrospinal fluid during attempted spinal anesthesia, subsequent anesthetic block during epidural placement, and detection of end-tidal carbon dioxide for endotracheal intubation.
An average of 77 +/- 9 epidural anesthetics, 44 +/- 6 spinal anesthetics, and 86 +/- 13 endotracheal intubations were attempted during the 6 months of training. The learning curves for each technique are of similar shape. Residents show significant (P < .05) improvement over baseline after 20 spinal and 25 epidural anesthetics, but a 90% success rate is not reached and maintained until 45 spinal and 60 epidural anesthetics are performed.
Approximately 20-25 procedures each are necessary before improvement in the techniques of spinal and epidural anesthesia is demonstrated by residents in training. If a 90% success rate is desired, 45 and 60 attempts at spinal and epidural anesthesia, respectively, may be necessary.
住院医师在培训期间接受的区域麻醉实践量存在很大差异。在学员熟练掌握这些区域麻醉技术之前，进行各种阻滞的尝试次数尚不清楚。本研究探讨的问题是：住院医师在这些技术的培训过程中，为达到操作的一致性，每种阻滞最少需要进行多少次？
记录了所有刚开始培训的CA-1麻醉科住院医师（n = 7）在培训的前6个月（1993年7月至1993年12月）每天尝试的每一种区域麻醉技术。同时记录尝试的非区域麻醉技术以作比较。用于定义成功程度的客观指标包括：在尝试脊髓麻醉时获取脑脊液、硬膜外穿刺置管后实现后续麻醉阻滞以及气管插管时检测到呼气末二氧化碳。
在6个月的培训期间，平均尝试了77±9次硬膜外麻醉、44±6次脊髓麻醉和86±13次气管插管。每种技术学习曲线的形状相似。住院医师在进行20次脊髓麻醉和25次硬膜外麻醉后，与基线相比有显著（P < 0.05）改善，但直到进行45次脊髓麻醉和60次硬膜外麻醉后，成功率才达到并维持在90%。
在培训中的住院医师表现出脊髓和硬膜外麻醉技术改善之前，每种大约需要进行20 - 25次操作。如果期望达到90%的成功率，则可能分别需要进行45次脊髓麻醉尝试和60次硬膜外麻醉尝试。
