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Ultrasound-Guided Regional Anesthesia Performance in the Early Learning Period: Effect of Simulation Training
  1. Ahtsham Uddin Niazi, FRCPC,
  2. Nidhi Haldipur, BSc,
  3. Arun G. Prasad, FRCPC and
  4. Vincent W. Chan, FRCPC
  1. From the Department of Anesthesia, Toronto Western Hospital, University Health Network, Ontario, Canada.
  1. Address correspondence to: Ahtsham Uddin Niazi, FRCPC, Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8 (e-mail: ahtsham.niazi{at}


Background and Objectives Success in performing ultrasound-guided peripheral nerve blockade (PNB) demands sound knowledge of sonoanatomy, good scanning techniques, and proper hand-eye coordination. The objectives of our study were to evaluate whether simulator training aids success of novice operators in ultrasound-guided PNB and to determine what number of procedures is required to attain proficiency.

Methods Twenty Postgraduate Year 2 anesthesiology residents with no previous experience in ultrasound-guided PNB were randomly assigned into 2 groups. Both groups received conventional teaching comprising of 4 didactic lectures on PNBs with ultrasound guidance. Using a low-fidelity simulation model, 1 group further received an hourlong training session on needling and proper hand-eye coordination. Once the training was over, the residents started their rotation through our block room. Using a logbook, each resident recorded the number of successful and failed ultrasound-guided regional anesthesia blocks performed over a 3-week period. A successful block was defined as one that was effective for surgical anesthesia and performed within 15 mins, with only verbal guidance from a staff anesthesiologist. Cumulative summation charts were created to track progress using a predetermined acceptable failure rate of 30%.

Results The conventional training group had 98 successful blocks, and the simulation group had 144 (51.3% vs 64%; P = 0.016). In the conventional training group, 4 of 10 residents achieved proficiency, and in the simulation training group, 8 of 10 residents achieved proficiency (80% vs 40%; P = 0.0849).

Conclusions Simulation training improves success rate in ultrasound-guided performance of regional anesthesia.

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  • The authors declare no conflict of interest.

  • This project was completely funded by internal departmental funding.