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Learning curve for the ultrasound anatomy of the brachial plexus in the axillary region.

Abstract：

BACKGROUND AND OBJECTIVES:Proficiency in ultrasound-guided blocks demands four skills: recognition of the ultrasound anatomy, capacity to generate images, aligning the needle with the ultrasound beam, and recognizing the dispersion of the local anesthetic. The objective of this study was to construct and evaluate learning curves for image generation and ultrasound identification of the neurovascular structures in the axilla. METHODS:Seven Anesthesiology residents received theoretical and practical notions on the basic principles of ultrasound and the ultrasound anatomy of the axillary region with the objective to identify the terminal branches of the brachial plexus and axillary vessels. Each resident performed six exams. The accuracy and the time to identify the structures were evaluated. The success rate of each exam was calculated. Simple linear regression evaluated the time necessary to identify each structure in relation to the number of the exam. RESULTS:The axillary vessels were identified in 100% of the exams. The median nerve was identified in 83% of the cases from the first to the fifth exams. The radial nerve was identified in 100% of the exams. The ulnar nerve was identified in 67% of the cases in the first exam, and in 83% of the cases from the second to the fifth exams. The musculocutaneous nerve was identified in 50% of the cases in the first exam and in 83% of the cases in the fourth and fifth exams. All structures were identified correctly on the sixth exam. The mean time for the correct identification of the structures decreased considerably from the first to the sixth exam (r = - 0.37). CONCLUSIONS:Learning progression required the memorization of the ultrasound anatomy of the axillary region and acquisition of manual ability, and increasing success rates were associated with a significant reduction in the time to identify the structures.

journal_name

Rev Bras Anestesiol

journal_title

Revista brasileira de anestesiologia

authors

Helayel PE,Conceição DB,Nascimento BS,Kohler A,Boos GL,Oliveira Filho GR

doi

10.1590/s0034-70942009000200006

subject

Has Abstract

pub_date

2009-03-01 00:00:00

pages

187-93

issue

eissn

0034-7094

issn

1806-907X

pii

S0034-70942009000200006

journal_volume

pub_type

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Learning curve for the ultrasound anatomy of the brachial plexus in the axillary region.