Background and Aims 23% of UK parturients have a BMI of greater than 30 [1], presenting additional challenges for neuraxial anaesthesia. Our previous project showed reductions in time to complete and number of re-angulations with ultrasound. Since then we have performed qualitative research and training to increase its use.

Methods Our survey examined neuraxial ultrasound confidence and belief in speed and safety of ultrasound for difficult cases on 0–10 Likert scales, and barriers to use qualitatively. A working registrar on a 6 month placement provided 25 opportunistic sessions of in-situ demonstrations and hands on practice on patients, then re-studied these parameters and compared responses with a paired t-test.

Results Mean starting confidence was only 3 out of 10, equal for consultants and registrars. Belief in quicker difficult spinals with ultrasound was 5.6 overall but only 4.75 in consultants, belief in improved safety was 6.1, or only 5.3 in consultants. Following a hands-on supervised practice session, confidence improved by 2.8 (p 0.01) points and belief in improvements in speed and safety increased by 1.8 and 1.3 respectively (not significant). An observation session did not improve confidence.

Conclusions Despite all of our anaesthetists having had prior teaching sessions on neuraxial ultrasound, confidence in performing the procedure was low. Hands-on practice on real patients was required to improve confidence to use this technique in practice. Barriers to use shifted from need for practice and training, unfamiliarity, lack of experience and knowledge to confidence, time and busyness.