Defining an Ultrasound‐guided Regional Anesthesia Curriculum for Emergency Medicine

Abstract

Objectives: Ultrasound-guided regional anesthesia (UGRA) can be a powerful tool in the treatment of painful conditions commonly encountered in emergency medicine (EM) practice. UGRA can benefit patients while avoiding the risks of procedural sedation and opioid-based systemic analgesia. Despite these advantages, many EM trainees do not receive focused education in UGRA and there is no published curriculum specifically for EM physicians. The objective of this study was to identify the components of a UGRA curriculum for EM physicians.Methods: A list of potential curriculum elements was developed through an extensive literature review. An expert panel was convened that included 13 ultrasound faculty members from 12 institutions and from a variety of practice environments and diverse geographical regions. The panel voted on curriculum elements through two rounds of a modified Delphi process. Results:The panelists voted on 178 total elements, 110 background knowledge elements, and 68 individual UGRA techniques. A high level of agreement was achieved for 65 background knowledge elements from the categories: benefits to providers and patients, indications, contraindications, risks, ultrasound skills, procedural skills, sterile technique, local anesthetics, and educational resources. Ten UGRA techniques achieved consensus: interscalene brachial plexus, supraclavicular brachial plexus, radial nerve, median nerve, ulnar nerve, serratus anterior plane, fascia iliaca, femoral nerve, popliteal sciatic nerve, and posterior tibial nerve blocks. Conclusions:The defined curriculum represents ultrasound expert opinion on a curriculum for training practicing EM physicians. This curriculum can be used to guide the development and implementation of more robust UGRA education for both residents and independent providers.

A consensus list of ultrasound competencies for graduating emergency medicine residents

“…While our procedures section specifically listed individual procedures, we did not specifically mention individual regional nerve blocks and instead chose to include an all‐encompassing question because previous studies have already defined an ultrasound guided regional nerve block curriculum using a modified Delphi technique. 62 …”

“…Furthermore, the general consensus was that residents should not be expected to specifically identify all of these abnormalities but should instead recognize that an abnormality exists and appropriately follow up with further imaging, consultation, or additional workup. While our procedures section specifically listed individual procedures, we did not specifically mention individual regional nerve blocks and instead chose to include an all‐encompassing question because previous studies have already defined an ultrasound guided regional nerve block curriculum using a modified Delphi technique 62 …”

“…While our procedures section specifically listed individual procedures, we did not specifically mention individual regional nerve blocks and instead chose to include an all-encompassing question because previous studies have already defined an ultrasound guided regional nerve block curriculum using a modified Delphi technique. 62 Our Delphi group had a robust discussion about the physics topics included in our questionnaire. Unsurprisingly, ultrasound experts considered understanding of common artifacts to be an important and clinically relevant skill for EM residents to avoid misdiagnosing artifacts as pathology and to also recognize normal anatomy accurately.…”

Evaluation of a Precision Approach to Intraoperative Ropivacaine Nerve Block to Improve Postoperative Analgesia in 120 Patients Undergoing Thyroid Surgery

“…With the development of technology, an increasing number of anesthesiologists use visual imaging techniques such as ultrasound to achieve a precise anesthesia effect [ 15 , 16 ]. During thyroid surgery, the separation level of the cervical skin flap is the loose connective tissue of the deep surface of the platysma muscle, which is also the level where the transverse cervical nerve and the supraclavicular nerve are located in.…”

Regional Anesthesia in the Emergency Department: an Overview of Common Nerve Block Techniques and Recent Literature

“…The panel identified and organized 65 core curricular elements into 10 categories: patient benefits, provider benefits, risks, indications, contraindications, LAs, sterile technique, ultrasound skills, procedural skills, and educational resources [48, 74•]. Ten UGRA techniques achieved consensus as likely beneficial to the practice of EM: IBPB, supraclavicular brachial plexus, radial nerve, median nerve, ulnar nerve, serratus anterior plane, FICB, FNB, popliteal sciatic nerve, and posterior tibial nerve blocks [48].…”