Validity and reliability of metrics for translation of regional anaesthesia performance from cadavers to patients

McLeod, Graeme; McKendrick, Mel; Taylor, Alasdair; Lynch, Joanna; Ker, Jean; Sadler, Amy; Halcrow, Jayne; McKendrick, Greer; Mustafa, Ayman; Seeley, J.; Raju, P. K.; Corner, George

doi:10.1016/j.bja.2019.04.060

Cited by 19 publications

(25 citation statements)

References 39 publications

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“…Nerve histology approximates that of humans 10 . Tissue elasticity is retained 11 and confers several benefits. Perineural injection distends then relaxes tissue within the same timeframe as during injection of local anesthetic during clinical nerve block.…”

Section: Discussionmentioning

confidence: 99%

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Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection

McLeod

Zihang

Sadler

et al. 2021

Reg Anesth Pain Med

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IntroductionAlthough administration of regional anesthesia nerve blocks has increased during the COVID-19 pandemic, training opportunities in regional anesthesia have reduced. Simulation training may enhance skills, but simulators must be accurate enough for trainees to engage in a realistic way—for example, detection of excessive injection pressure. The soft-embalmed Thiel cadaver is a life-like, durable simulator that is used for dedicated practice and mastery learning training in regional anesthesia. We hypothesized that injection opening pressure in perineural tissue, at epineurium and in subepineurium were similar to opening pressures measured in experimental animals, fresh frozen cadavers, glycol soft-fix cadavers and patients.MethodsWe systematically reviewed historical data, then conducted three validation studies delivering a 0.5 mL hydrolocation bolus of embalming fluid and recording injection pressure. First, we delivered the bolus at 12 mL/min at epimysium, perineural tissue, epineurium and in subepineurium at 48 peripheral nerve sites on three cadavers. Second, we delivered the bolus at using three infusion rates: 1 mL/min, 6 mL/min and 12 mL/min on epineurium at 70 peripheral nerve sites on five cadavers. Third, we repeated three injections (12 mL/min) at 24 epineural sites over the median and sciatic nerves of three cadavers.ResultsMean (95%) injection pressure was greater at epineurium compared with subepineurium (geometric ratio 1.2 (95% CI: 0.9 to 1.6)), p=0.04, and perineural tissue (geometric ratio 5.1 (95% CI: 3.7 to 7.0)), p<0.0001. Mean (95%) injection pressure was greater at 12 mL/min compared with 1 mL/min (geometric ratio 1.6 (95% CI: 1.2 to 2.1), p=0.005). Pressure measurements were similar in study 3 (p>0.05 for all comparisons).DiscussionWe conclude that the soft-embalmed Thiel cadaver is a realistic simulator of injection opening pressure.

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Section: Discussionmentioning

confidence: 99%

“…The functionality of the soft embalmed cadaver has enabled us to change the way we train in regional anesthesia. We use dedicated, repetitive practice and mastery learning 11 and quantitative measurement of learning curves 3 using validated task and error checklists 11 .…”

Section: Discussionmentioning

confidence: 99%

Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection

McLeod

Zihang

Sadler

et al. 2021

Reg Anesth Pain Med

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“…We generated learning curves because we were consistently able to repeat injections on the soft embalmed cadaver simulator. Our studies [6,7] are consistently This study is the first study we are aware of to train and test a complex anaesthetic procedure to medical students on a high-fidelity simulator. No differences were observed in psychometric data, steps, errors, efficiency, selfconfidence, self-assessment or eye-tracking metrics between students and anaesthetists.…”

Section: Methodsmentioning

confidence: 75%

“…We devised a key performance indicator (KPI) based on 21 out of 30 independent items from our validated checklist [6]. It consisted of 15 steps and 6 errors (Nos.…”

Section: Methodsmentioning

confidence: 99%

“…Our group has sought to improve training by using a soft embalmed Thiel cadaver simulator [5], application of mastery learning techniques [4], quantitative measurement of performance using validated checklists of steps and errors [6] and eye-tracking analysis [3,6,7]. The most difficult tasks encountered by trainees were viewing the needle tip at all times, recognition of needle-nerve contact and detection of intraneural injection [6].…”

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confidence: 99%

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The effect of an ultrasound‐activated needle tip tracker needle on the performance of sciatic nerve block on a soft embalmed Thiel cadaver

et al. 2020

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Summary In this study, we measured the performance of medical students and anaesthetists using a new tracker needle during simulated sciatic nerve block on soft embalmed cadavers. The tracker needle incorporates a piezo element near its tip that generates an electrical signal in response to insonation. A circle, superimposed on the ultrasound image surrounding the needle tip, changes size and colour according to the position of the piezo element within the ultrasound beam. Our primary objective was to compare sciatic block performance with the tracker switched on and off. Our secondary objectives were to record psychometrics, procedure efficiency, participant self‐regulation and focused attention using eye‐tracking technology. Our primary outcome measures were the number of steps successfully performed and the number of errors committed during each block. Videos were scored by trained experts using validated checklists. Sequential tracker activation and deactivation was randomised equally within subjects. With needle activation, steps improved in 10 (25%) subjects and errors reduced in six (15%) subjects. The most important steps were: needle tip identification before injection, OR (95%CI) 2.12 (1.61–2.80; p < 0.001); and needle tip identification before advance of the needle, 1.80 (1.36–2.39; p < 0.001). The most important errors were: failure to identify the needle tip before injection, 2.40 (1.78–3.24; p < 0.001); and failure to quickly regain needle tip position when tip visibility was lost, 2.03 (1.5–2.75; p < 0.001). In conclusion, needle‐tracking technology improved performance in a quarter of subjects.

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Implementing ultrasound‐guided nerve blocks in the emergency department: A low‐cost, low‐fidelity training approach

Walsh,

Ma,

Eyre

et al. 2023

AEM Education and Training

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BackgroundManaging acute pain is a common challenge in the emergency department (ED). Though widely used in perioperative settings, ED‐based ultrasound‐guided nerve blocks (UGNBs) have been slow to gain traction. Here, we develop a low‐cost, low‐fidelity, simulation‐based training curriculum in UGNBs for emergency physicians to improve procedural competence and confidence.MethodsIn this pre‐/postintervention study, ED physicians were enrolled to participate in a 2‐h, in‐person simulation training session composed of a didactic session followed by rotation through stations using handmade pork‐based UGNB models. Learner confidence with performing and supervising UGNBs as well as knowledge and procedural‐based competence were assessed pre‐ and posttraining via electronic survey quizzes. One‐way repeated‐measures ANOVAs and pairwise comparisons were conducted. The numbers of nerve blocks performed clinically in the department pre‐ and postintervention were compared.ResultsIn total, 36 participants enrolled in training sessions, eight participants completed surveys at all three data collection time points. Of enrolled participants, 56% were trainees, 39% were faculty, 56% were female, and 53% self‐identified as White. Knowledge and competency scores increased immediately postintervention (mean ± SD t0 score 66.9 ± 8.9 vs. t1 score 90.4 ± 11.7; p < 0.001), and decreased 3 months postintervention but remained elevated above baseline (t2 scores 77.2 ± 11.5, compared to t0; p = 0.03). Self‐reported confidence in performing UGNBs increased posttraining (t0 5.0 ± 2.3 compared to t1 score 7.1 ± 1.5; p = 0.002) but decreased to baseline levels 3 months postintervention (t2 = 6.0 ± 1.9, compared to t0; p = 0.30).ConclusionsA low‐cost, low‐fidelity simulation curriculum can improve ED provider procedural‐based competence and confidence in performing UGNBs in the short term, with a trend toward sustained improvement in knowledge and confidence. Curriculum adjustments to achieve sustained improvement in confidence performing and supervising UGNBs long term are key to increased ED‐based UGNB use.

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Validity and reliability of metrics for translation of regional anaesthesia performance from cadavers to patients

Cited by 19 publications

References 39 publications

Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection

Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection

The effect of an ultrasound‐activated needle tip tracker needle on the performance of sciatic nerve block on a soft embalmed Thiel cadaver

Implementing ultrasound‐guided nerve blocks in the emergency department: A low‐cost, low‐fidelity training approach

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