Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia.

Abstract:

BACKGROUND AND OBJECTIVES:Ultrasound-guided regional anesthesia is a rapidly growing field. There exists little information regarding the competencies involved with such a practice. The objective of this exploratory study was to characterize the behavior of novices as they undertook the challenges of learning a new technique. In addition to assessing for both committed errors and accuracy, we aimed to identify previously unrecognized quality-compromising behaviors that could help structure effective training interventions. METHODS:By using detailed video analyses, the performances of 6 anesthesia residents were evaluated while on a dedicated 1-month rotation in ultrasound-guided regional anesthesia. From these video reviews, we assessed accuracy, errors committed, performance times, and searched for previously unrecognized quality-compromising behaviors. RESULTS:A total of 520 nerve blocks were videotaped and reviewed. All residents performed at least 66 nerve blocks, with an overall success rate of 93.6% and 4 complications. Both speed and accuracy improved throughout the rotation. There were a total of 398 errors committed, with the 2 most common errors consisting of the failure to visualize the needle before advancement and unintentional probe movement. Five quality-compromising patterns of behavior were identified: (1) failure to recognize the maldistribution of local anesthesia, (2) failure to recognize an intramuscular location of the needle tip before injection, (3) fatigue, (4) failure to correctly correlate the sidedness of the patient with the sidedness of the ultrasound image, and (5) poor choice of needle-insertion site and angle with respect to the probe preventing accurate needle visualization. CONCLUSIONS:Based on the analysis of the committed errors and the identification of quality-compromising behaviors, we are able to recommend important targets for learning in future training and simulation programs.

journal_name

Reg Anesth Pain Med

authors

Sites BD,Spence BC,Gallagher JD,Wiley CW,Bertrand ML,Blike GT

doi

10.1016/j.rapm.2006.11.006

subject

Has Abstract

pub_date

2007-03-01 00:00:00

pages

107-15

issue

2

eissn

1098-7339

issn

1532-8651

pii

S1098-7339(06)00646-8

journal_volume

32

pub_type

杂志文章
  • Intrathecal mepivacaine and prilocaine are less neurotoxic than lidocaine in a rat intrathecal model.

    abstract:BACKGROUND AND OBJECTIVES:Histologic evidence of the comparative neurotoxicity of lidocaine, mepivacaine, and prilocaine is incomplete. We compared the intrathecal neurotoxicity in rats among these 3 drugs based on morphologic and neurofunctional findings. METHODS:Rats (n=169) randomly received 0.12 microL/g of 0%, 2%...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/j.rapm.2004.06.013

    authors: Takenami T,Yagishita S,Nara Y,Hoka S

    更新日期:2004-09-01 00:00:00

  • Local anesthetics in lipid-depot formulations--neurotoxicity in relation to duration of effect in a rat model.

    abstract:BACKGROUND AND OBJECTIVES:The aim of this study was to investigate the possible local neurotoxicity of a number of lipid-depot formulations of local anesthetics in relation to their duration of action in sciatic-nerve block. METHODS:Formulations that contain 2%, 4%, 8%, 16%, 32%, or 64% of a mixture of bupivacaine and...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/j.rapm.2006.05.008

    authors: Dyhre H,Söderberg L,Björkman S,Carlsson C

    更新日期:2006-09-01 00:00:00

  • Accuracy and consistency of modern elastomeric pumps.

    abstract::Continuous peripheral nerve blockade has become a popular method of achieving postoperative analgesia for many surgical procedures. The safety and reliability of infusion pumps are dependent on their flow rate accuracy and consistency. Knowledge of pump rate profiles can help physicians determine which infusion pump i...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000130

    authors: Weisman RS,Missair A,Pham P,Gutierrez JF,Gebhard RE

    更新日期:2014-09-01 00:00:00

  • The effect of nitrous oxide anesthesia on early postoperative opioid consumption and pain.

    abstract:BACKGROUND AND OBJECTIVES:Many patients experience moderate to severe postoperative pain. Nitrous oxide (N₂O) exerts analgesia by inhibition of N-methyl-D-aspartate receptors. Ketamine, another N-methyl-D-aspartate receptor antagonist, reduces postoperative opioid consumption and pain. A similar effect of N₂O is plausi...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/AAP.0000000000000039

    authors: Duma A,Helsten D,Brown F,Bottros MM,Nagele P

    更新日期:2014-01-01 00:00:00

  • Radiofrequency Procedures to Relieve Chronic Hip Pain: An Evidence-Based Narrative Review.

    abstract:BACKGROUND AND OBJECTIVES:Chronic hip pain from osteoarthritis and other degenerative conditions is a common problem. A few publications have recently reported analgesic success of radiofrequency (RF) procedures on nerves innervating the hip, but interpretation is hampered by lack of clarity regarding indications, clin...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,评审

    doi:10.1097/AAP.0000000000000694

    authors: Bhatia A,Hoydonckx Y,Peng P,Cohen SP

    更新日期:2018-01-01 00:00:00

  • Functional deficits after intraneural injection during interscalene block.

    abstract:OBJECTIVE:We present an occurrence of a severe but transient neurologic complication after intraneural injection during an ultrasound-guided interscalene block. CASE REPORT:A 36-year-old man underwent ultrasound-guided interscalene nerve blockade before shoulder incision and drainage. On postoperative day 1, he exhibi...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/aap.0b013e3181e8a35f

    authors: Cohen JM,Gray AT

    更新日期:2010-07-01 00:00:00

  • Analgesia and anesthesia using the pericapsular nerve group block in hip surgery and hip fracture: a scoping review.

    abstract:INTRODUCTION:Pericapsular nerve group (PENG) block is a novel regional analgesia technique to reduce pain after hip surgery and hip fractures. This review was conducted to summarize current literature. METHODS:A scoping review was carried out using the Joanna Briggs Institute framework. All articles describing the use...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,评审

    doi:10.1136/rapm-2020-101826

    authors: Morrison C,Brown B,Lin DY,Jaarsma R,Kroon H

    更新日期:2021-02-01 00:00:00

  • Interscalene block with a nerve stimulator: a deltoid motor response is a satisfactory endpoint for successful block.

    abstract:BACKGROUND AND OBJECTIVES:The interscalene brachial plexus block (ISB) is an effective and well-established anesthetic technique for shoulder surgery. Using nerve stimulation as an aid in block placement, a motor response (twitch) in the biceps or a more distal upper limb muscle has been recommended to indicate accurat...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章

    doi:10.1053/rapm.2000.7597

    authors: Silverstein WB,Saiyed MU,Brown AR

    更新日期:2000-07-01 00:00:00

  • An animal model of "syringe feel" during peripheral nerve block.

    abstract:BACKGROUND:The perception of high resistance during injection of a local anesthetic during regional anesthesia may indicate intraneural injection. Anesthetists' ability to detect high resistance by "syringe feel" has been questioned in the past. The aim of our study was to investigate the anesthetist's ability to detec...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/aap.0b013e3181ac7f38

    authors: Theron PS,Mackay Z,Gonzalez JG,Donaldson N,Blanco R

    更新日期:2009-07-01 00:00:00

  • Development and Validation of an Assessment of Regional Anesthesia Ultrasound Interpretation Skills.

    abstract:BACKGROUND:Interpretation of ultrasound images and knowledge of anatomy are essential skills for ultrasound-guided peripheral nerve blocks. Competency-based educational models promoted by the Accreditation Council for Graduate Medical Education require the development of assessment tools for the achievement of differen...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/AAP.0000000000000236

    authors: Woodworth GE,Carney PA,Cohen JM,Kopp SL,Vokach-Brodsky LE,Horn JL,Missair A,Banks SE,Dieckmann NF,Maniker RB

    更新日期:2015-07-01 00:00:00

  • Calciphylaxis treated with neurolytic lumbar sympathetic block: case report and review of the literature.

    abstract:BACKGROUND AND OBJECTIVE:Calciphylaxis is a painful complication of end-stage renal disease and secondary hyperparathyroidism. Calcification most commonly affects skin and soft tissue of the lower extremities resulting in excruciatingly painful skin ulcers. Treatment involves correction of hypercalcemia and hyperphosph...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/s1098-7339(00)90018-x

    authors: Green JA,Green CR,Minott SD

    更新日期:2000-05-01 00:00:00

  • The analgesic effects of perioperative gabapentin on postoperative pain: a meta-analysis.

    abstract:BACKGROUND AND OBJECTIVES:Gabapentin is an anticonvulsant that has been shown to be effective in the treatment of neuropathic and inflammatory pain in animal and human studies. The analgesic effect of its perioperative use has not been fully elucidated. METHODS:This systematic review (meta-analysis) included 12 random...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章,meta分析

    doi:10.1016/j.rapm.2006.01.005

    authors: Hurley RW,Cohen SP,Williams KA,Rowlingson AJ,Wu CL

    更新日期:2006-05-01 00:00:00

  • Progression of forearm intravenous regional anesthesia with ropivacaine.

    abstract::The progression of sensory blockade in the hand following a forearm Bier block with ropivacaine is currently unknown. The hands of 10 healthy adult human subjects were anesthetized with ropivacaine, and their sensitivities to cold and touch were tested until the completion of anesthesia. On average, insensitivity to c...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0b013e31820d42ed

    authors: Horn JL,Cordo P,Künster D,Harvey C,Cherry A,Bratt A,Gurfinkel V

    更新日期:2011-03-01 00:00:00

  • Efficacy of oral mexiletine for neuropathic pain with allodynia: a double-blind, placebo-controlled, crossover study.

    abstract:BACKGROUND AND OBJECTIVES:Mexiletine is an oral sodium channel antagonist that has been reported to be effective in a variety of neuropathic pain syndromes. However, recent reports question the efficacy of oral mexiletine in neuropathic pain. The objectives of this study were to examine the effect of oral mexiletine on...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1053/rapm.2000.8583

    authors: Wallace MS,Magnuson S,Ridgeway B

    更新日期:2000-09-01 00:00:00

  • A case report of reappearance of spinal anesthesia.

    abstract:OBJECTIVE:We present a case of reappearance of spinal anesthesia despite the use of plain (isobaric) lidocaine and without an associated cough or Valsalva maneuver. CASE REPORT:A 66-year-old man had spinal anesthesia for knee arthroscopy. Two hours after the induction of spinal anesthesia and after the patient's motor...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/j.rapm.2007.11.007

    authors: Deleon AM,Benzon HT,Eisenman TS,Doty RA Jr,Newell B,McLaughlin K

    更新日期:2008-05-01 00:00:00

  • Anatomical analysis of medial branches of dorsal rami of cervical nerves for radiofrequency thermocoagulation.

    abstract:BACKGROUND AND OBJECTIVES:Cervical medial branch blocks are used to treat patients with chronic neck pain. The aim of this study was to clarify the anatomical aspects of the cervical medial branches to improve the accuracy and safety of radiofrequency denervation. METHODS:Twenty cervical specimens were harvested from ...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000175

    authors: Kweon TD,Kim JY,Lee HY,Kim MH,Lee YW

    更新日期:2014-11-01 00:00:00

  • Regional to the Rescue! Axillary Brachial Plexus Nerve Block Facilitates Removal of Entrapped Transradial Catheter Placed for Cardiac Catheterization.

    abstract:OBJECTIVE:Our objective was to describe the first reported use of an axillary brachial plexus block to treat the entrapment of a transradial artery catheter due to vasospasm. CASE REPORT:A 42-year-old man undergoing transradial arterial cardiac catheterization suffered arterial vasospasm causing the catheter to become...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000595

    authors: Fitzgerald BM,Babbel LA,Bacomo FK,Dhanjal ST

    更新日期:2017-07-01 00:00:00

  • Epidural catheter placement in neonates: sonoanatomy and feasibility of ultrasonographic guidance in term and preterm neonates.

    abstract:BACKGROUND:We report the first prospective sonoanatomic study in neonates with the aim to perform ultrasonographic-guided epidural catheter placement in this age group. METHOD:One hundred forty-five neonates with a body weight < or =4 kg (0.53-4 kg) were included in this prospective study. The study was divided into 3...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/j.rapm.2006.10.008

    authors: Willschke H,Bosenberg A,Marhofer P,Willschke J,Schwindt J,Weintraud M,Kapral S,Kettner S

    更新日期:2007-01-01 00:00:00

  • Epidural clonidine relieves intractable neuropathic itch associated with herpes zoster-related pain.

    abstract:OBJECTIVE:We present a case of intense herpes zoster-related pain and itching in the ophthalmic division of the trigeminal nerve (V1). Successful pain and itch management was achieved after insertion of a high thoracic epidural catheter with a continuous infusion of bupivacaine and clonidine. CASE REPORT:A 73-year-old...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/s1098-7339(03)00182-2

    authors: Elkersh MA,Simopoulos TT,Malik AB,Cho EH,Bajwa ZH

    更新日期:2003-07-01 00:00:00

  • Minimum current requirements for epidural stimulation test confirmation of epidural and intrathecal catheter placement.

    abstract:BACKGROUND AND OBJECTIVES:The typical blind insertion of a catheter into the epidural space risks catheter misplacement into the intrathecal space. The epidural stimulation test is designed to confirm the correct epidural location of a catheter but may also detect unintended intrathecal catheter placement by evaluating...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/aap.0b013e3181bfbe1e

    authors: Sutherland MA,Viscomi CM,Dominick TS,Anderson EL

    更新日期:2009-11-01 00:00:00

  • Preparing for the physician payment sunshine act.

    abstract::In March of 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act, ushering in an era of health care reform. Section 6002 of the bill, the Physician Payment Sunshine Act, requires manufacturers of drugs, devices, biological therapeutics, and medical supplies to disclose to the Cen...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000074

    authors: Dickerson DM,Naidu RK

    更新日期:2014-05-01 00:00:00

  • Ultrasound Identification of Diaphragm by Novices Using ABCDE Technique.

    abstract:BACKGROUND AND OBJECTIVES:In this study, we examined the consistency, rapidity, and reproducibility of the ABCDE technique for diaphragm identification. Operators using this method place the probe at the Anterior axillary line, watch for Breathing (lung sliding), and then move the probe Caudally to identify the Diaphra...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0000000000000718

    authors: Khurana J,Gartner SC,Naik L,Tsui BCH

    更新日期:2018-02-01 00:00:00

  • Enhancement of axillary brachial plexus block anesthesia by coadministration of neostigmine.

    abstract:BACKGROUND AND OBJECTIVES:The acetylcholinesterase inhibitor neostigmine has shown peripherally mediated analgesic action in recent preclinical and clinical studies. The present study investigates the effectiveness of adding neostigmine to a local anesthetic, mepivacaine, in patients receiving axillary brachial plexus ...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s1098-7339(99)90005-6

    authors: Bone HG,Van Aken H,Booke M,Bürkle H

    更新日期:1999-09-01 00:00:00

  • Electron-microscopic imaging of endothoracic fascia in the thoracic paravertebral space in rats.

    abstract:BACKGROUND AND OBJECTIVES:Anesthesia and analgesia with paravertebral block are reportedly variable. Existence of an endothoracic fascia has been proposed as one of the possible mechanisms leading to variability. We undertook an electron-microscopy imaging study to investigate the endothoracic fascia in the thoracic pa...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1097/AAP.0b013e31824451cb

    authors: Stopar Pintaric T,Veranic P,Hadzic A,Karmakar M,Cvetko E

    更新日期:2012-03-01 00:00:00

  • Intrathecal labor analgesia with bupivacaine and sufentanil: the effect of adding 2.25 microg epinephrine.

    abstract:BACKGROUND AND OBJECTIVES:Epinephrine, 25 microg and 200 microg, has been found to prolong the duration of intrathecal labor analgesia when added to an opioid. In our hospital we use the standard epidural mixture, prepared by the pharmacist, containing epinephrine 1:800,000; i.e., 1.25 microg/mL for both spinal and epi...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1053/rapm.2001.24406

    authors: Vercauteren MP,Jacobs S,Jacquemyn Y,Adriaensen HA

    更新日期:2001-09-01 00:00:00

  • Exploration of Gender-Specific Authorship Disparities in the Pain Medicine Literature.

    abstract:BACKGROUND:Given the readily increasing membership of the pain physician community, efforts toward correcting notable gender disparities are instrumental. The under-representation of women is particularly prevalent within leadership roles in academic medicine, thought to be driven largely by diminished research efforts...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1136/rapm-2019-100806

    authors: Karri J,Navarro SM,Duong A,Tang T,Abd-Elsayed A

    更新日期:2019-11-02 00:00:00

  • Infraclavicular plexus block: multiple injection versus single injection.

    abstract:BACKGROUND AND OBJECTIVES:This prospective, randomized, and multicentered study was undertaken to evaluate the success rate of coracoid infraclavicular nerve block performed with a nerve stimulator when either 1 or 3 motor responses were sought. METHODS:Eighty patients who presented for elbow, forearm, or wrist surger...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验

    doi:10.1053/rapm.2002.36456

    authors: Gaertner E,Estebe JP,Zamfir A,Cuby C,Macaire P

    更新日期:2002-11-01 00:00:00

  • Cholestasis as a side effect of bupivacaine?

    abstract:BACKGROUND AND OBJECTIVES:Cholestasis has been proposed as a side effect of interpleural bupivacaine. Therefore, the effects of various application techniques on liver enzymes were studied following ethics committee approval and informed patient consent. METHODS:Patients following scheduled thoracotomy and laparoscopi...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1016/s1098-7339(98)90055-4

    authors: Wulf H,Leger R,Raetzell M,Olmer A,Scheiderer U

    更新日期:1998-05-01 00:00:00

  • Effect of systemic adenosine on pain and secondary hyperalgesia associated with the heat/capsaicin sensitization model in healthy volunteers.

    abstract:BACKGROUND AND OBJECTIVES:Adenosine is an endogenous compound that may have analgesic effects. Results from clinical trials are not consistent, however, and there is a need for large-scale, randomized, placebo-controlled studies to clarify the role of adenosine in the treatment of pain states, including acute nocicepti...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 临床试验,杂志文章,随机对照试验

    doi:10.1053/rapm.2001.22256a

    authors: Dirks J,Petersen KL,Rowbotham MC,Dahl JB

    更新日期:2001-09-01 00:00:00

  • Ultrasound-guided posterior approach for the placement of a continuous interscalene catheter.

    abstract:BACKGROUND AND OBJECTIVES:The posterior approach to performing a continuous brachial plexus block at the level of the nerve roots has been described using traditional superficial landmarks. We describe an ultrasound-guided approach for the placement of a continuous interscalene brachial plexus catheter at the level of ...

    journal_title:Regional anesthesia and pain medicine

    pub_type: 杂志文章

    doi:10.1016/AAP.0b013e3181933a53

    authors: Antonakakis JG,Sites BD,Shiffrin J

    更新日期:2009-01-01 00:00:00