Article Text

Value of an Electronic Tutorial for Image Interpretation in Ultrasound-Guided Regional Anesthesia
  1. Jessica T. Wegener, MD,
  2. C. Thea van Doorn, MD,
  3. Jan H. Eshuis, MD,
  4. Markus W. Hollmann, MD, PhD,
  5. Benedikt Preckel, MD, MA and
  6. Markus F. Stevens, MD, PhD
  1. Department of Anesthesiology, Academic Medical Center, University of Amsterdam, the Netherlands.
  1. Address correspondence to: Benedikt Preckel, MD, MA, Department of Anesthesiology, Academic Medical Center, Meibergdreef 9, 1100DD Amsterdam, the Netherlands (e-mail: b.preckel{at}


Background and Objectives Use of ultrasound-guided regional anesthesia (UGRA) requires considerable training. An embedded electronic tutorial as an element of an ultrasound machine may help to identify sonoanatomy for novices. Therefore, we investigated whether an electronic tutorial could improve accuracy or speed of performance in identifying anatomical structures.

Methods Thirty-five novices in UGRA participated in a workshop on brachial plexus sonoanatomy. Following a lecture and training in handling of ultrasound machines and hand-eye coordination, participants were randomized in either group S, using a standard ultrasound machine, or group T, using the same type of machine with an onboard electronic tutorial. Each participant had to identify 27 anatomical structures from the brachial plexus of a volunteer. A correctly identified structure scored 1 point. An experienced observer noted scores and time required. Scores ± SD (in %) and times ± SD (in seconds) were compared between groups by analyses of independent-samples t test and analysis of variance. Influence of anesthesia experience was determined by multivariate analyses.

Results Group T scored significantly higher (16.8 ± 3.6 [62%] vs 13.4 ± 4.4 [50%], P = 0.018), whereas time required was longer (1053 ± 244 vs 740 ± 244 seconds, P = 0.001). Multivariate analysis revealed that experience had no influence on scores or time required. Examination of structures took more time in the beginning than at the end in group T.

Conclusions An electronic tutorial can help novices in UGRA identify anatomical structures. A significant increase in correct identifications was gained at the expense of significantly longer time required for this process. Increased time required may partly be related to unfamiliarity with the tutorial.

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  • The authors declare no conflict of interest.

    Joseph M. Neal, MD, served as editor-in-chief for this article.

    Financial support was provided from institutional sources. One ultrasound machine (MyLabOne) was offered for loan during the study. During the study, an additional US machine (MyLabOne) was provided by Esaoate spA, Genova, Italy. The company had no influence on study design, data acquisition, or preparation of the manuscript, and no other benefits were provided.

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