Bouaziz H, Mercier F J, Narchi P, Poupard M, Auroy Y, Benhamou D
Department of Anesthesiology, Hôpital Antoine-Béclère, Clamart, France.
Reg Anesth. 1997 May-Jun;22(3):218-22. doi: 10.1016/s1098-7339(06)80004-0.
A survey of anesthesia practice was conducted among French residents in anesthesia at the end of their training. This study was performed mainly to evaluate the residents' experience in peripheral nerve blocks.
Two short clinical cases were proposed to all French residents during a telephone interview immediately before their certification. The first described the case of a young asthmatic patient admitted for an elbow fracture. The second described an elderly woman with severe aortic stenosis admitted for a supracondylar fracture of the femur. A questionnaire had been prepared and was filled in during the interview. Each resident was asked to answer according to the actual choice he or she would have made. For both cases, when general anesthesia was chosen first, the next question was to discuss which regional anesthesia would be used if general anesthesia had to be discarded. In that way, the practical knowledge about most common peripheral nerve blocks learned during residency was investigated.
Of 77 residents registered as being at the end of their residency, 8 were on either sabbatical or maternity leave. Regional anesthesia was the first choice in 78% and 57% of cases for the first and second clinical cases, respectively. The regional anesthetic techniques chosen were axillary block (66%), interscalene block (31%), and intravenous regional anesthesia (3%) for case 1 and combined lumbar plexus and sciatic block (36%), epidural anesthesia (30%), single-shot spinal anesthesia (18%), and continuous spinal anesthesia (16%) for case 2. Throughout the residency of the group, 32 +/- 2 axillary blocks, 12 +/- 2 interscalene blocks (axillary vs interscalene, P < .0001), 21 +/- 3 femoral blocks, and 10 +/- 2 sciatic blocks (femoral vs sciatic, P < .0001) had been performed (mean +/- SEM). They had also performed 2.5 +/- 0.5 continuous spinal anesthesias and 17 +/- 3 intravenous regional anesthesias respectively. Upper extremity blocks were more often used during residency than lower extremity blocks (44 +/- 3 vs 31 +/- 4, P < .01). A peripheral nerve stimulator was routinely used by 83% of residents.
French residents in anesthesiology at time of certification are better trained for peripheral nerve blocks of the upper extremity than for those of the lower extremity. Axillary plexus and femoral nerve block are the most widely used blocks, probably reflecting the techniques the most mastered among teachers. Finally, the extensive use of a peripheral nerve stimulator by residents is probably the result of the widespread use of this device by teachers in France.
在法国麻醉住院医师培训结束时，对其麻醉实践进行了一项调查。本研究主要是为了评估住院医师在周围神经阻滞方面的经验。
在所有法国住院医师认证前，通过电话访谈向他们提出两个简短的临床病例。第一个病例描述了一名因肘部骨折入院的年轻哮喘患者。第二个病例描述了一名因股骨髁上骨折入院的患有严重主动脉瓣狭窄的老年女性。访谈期间准备并填写了一份问卷。要求每位住院医师根据其实际会做出的选择进行回答。对于这两个病例，若首先选择全身麻醉，接下来的问题是讨论如果必须放弃全身麻醉将使用哪种区域麻醉。通过这种方式，调查了住院医师在培训期间所学的关于最常见周围神经阻滞的实践知识。
在登记为培训结束的77名住院医师中，有8人正在休假或休产假。区域麻醉分别是第一个和第二个临床病例中78%和57%的病例的首选。对于病例1，选择的区域麻醉技术为腋路阻滞（66%）、肌间沟阻滞（31%）和静脉区域麻醉（3%）；对于病例2，选择的区域麻醉技术为腰丛联合坐骨神经阻滞（36%）、硬膜外麻醉（30%）、单次脊麻（18%）和连续脊麻（16%）。在该组住院医师的整个培训期间，平均进行了32±2次腋路阻滞、12±2次肌间沟阻滞（腋路阻滞与肌间沟阻滞相比，P<.0001）、21±3次股神经阻滞和10±2次坐骨神经阻滞（股神经阻滞与坐骨神经阻滞相比，P<.0001）。他们还分别进行了2.5±0.5次连续脊麻和17±3次静脉区域麻醉。上肢阻滞在住院医师培训期间的使用频率高于下肢阻滞（44±3次与31±4次，P<.01）。83%的住院医师常规使用外周神经刺激器。
法国麻醉学住院医师在认证时，在上肢周围神经阻滞方面的培训比下肢更好。腋路臂丛神经阻滞和股神经阻滞是使用最广泛的阻滞，这可能反映了教师中掌握得最好的技术。最后，住院医师对外周神经刺激器的广泛使用可能是由于该设备在法国教师中的广泛使用。
