A randomised controlled trial comparing meat-based with human cadaveric models for teaching ultrasound-guided regional anaesthesia

Abstract

The aim of this prospective, blinded, randomised controlled study was to compare novices' acquisition of the technical skills of ultrasound-guided regional anaesthesia using either a meat phantom model or fresh-frozen human cadavers. The primary outcome was the time taken to successfully perform an ultrasound-guided sciatic nerve block on a cadaver; secondary outcomes were the cumulative score of errors, and best image quality of the sciatic nerve achieved. After training, the median (IQR [range]) time taken to perform the block was 311(164-390 [68-600]) s in the meat model trained group and 210 (174-354 [85-600]) s in the fresh-frozen cadaver trained group (p = 0.24). Participants made a median (IQR [range]) of 18 (14-33 [8-55]) and 15 (12-22 [8-44]) errors in the two groups respectively (p = 0.39). The image quality score was also not different, with a median (IQR [range]) of 62.5 (59.4-65.6 [25.0-100.0])% vs 62.5 (62.5-75.0 [25.0-87.5])% respectively (p = 0.58). The training and deliberate feedback improved all participants' block performance, the median (IQR [range]) times being 310 (206-532 [110-600]) s before and 240 (174-354 [85-600]) s after training (p = 0.02). We conclude that novices taught ultrasound scanning and needle guidance skills using an inexpensive and easily constructed meat model perform similarly to those trained on a cadaveric model.

Research not research

“…The study by Chuan and colleagues published in this edition of Anaesthesia reports a blinded, randomised controlled study to compare novices' acquisition of the technical skills of ultrasound-guided regional anaesthesia using either a meat phantom model or fresh frozen human cadavers [5]. Their hypothesis was that training on a fresh frozen cadaver would enable candidates to learn the technique of needle localisation and injection of saline around the nerve more quickly compared with training on a porcine meat model.…”

Comparative Echogenicity of an Epidural Catheter and 2 New Catheters Designed for Ultrasound‐Guided Continuous Peripheral Nerve Blocks

“…However, this model has been previously described for ultrasound-guided regional anesthesia training [11][12][13] and has been validated against human cadaver models. 23 In addition, the results of this in vitro study cannot be generalized to clinical outcomes, since echogenic characteristics and a catheter's ultrasound visibility have not been shown to correlate with analgesic efficacy or sensory blockade. The echogenic characteristics reported in this study only apply to the specific catheter insertion technique and catheter equipment used; these results should not be generalized to other catheter types or insertion techniques that have not yet been studied by the same methods.…”

“…The simulated target was also relatively shallow (<3 cm), which may have negated any potential advantages of echogenic technology at greater depths. However, this model has been previously described for ultrasound‐guided regional anesthesia training and has been validated against human cadaver models . In addition, the results of this in vitro study cannot be generalized to clinical outcomes, since echogenic characteristics and a catheter's ultrasound visibility have not been shown to correlate with analgesic efficacy or sensory blockade.…”

The effect of a multidisciplinary care bundle on the incidence of delirium after hip fracture surgery: a quality improvement study

“…Fascia iliaca blocks were taught using volunteer models to demonstrate relevant sono‐anatomy. Ultrasound‐guided, real‐time needling practice used a validated pork model . Competency was assessed with a validated global rating scale, with all participants requiring a satisfactory grade, defined as a median score ≥ 3 . Standardised analgesia medication.…”