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Abstract
Background and Aims Identification of individual brachial plexus elements enables anaesthesiologists to perform site specific regional anaesthesia with low local anaesthetic volume and minimal complications.1This study explored the learning curves of anaesthesiology residents for identification of individual brachial plexus elements above the clavicle using a systematic sign-based scanning technique (SSBST).2
Methods After institutional ethics approval(PG DISSERTATION/02/2019/70)and registration in CTRI (CTRI/2019/05/019380), 22 residents were enrolled. All received teaching material and hands on training sessions related to SSBST. Resident scanning sessions were organised on pre-approved volunteers. The performance of the candidates were assessed by two consultants, using a SSBST proficiency scoring card (Figure 1). Residents periodically repeated sessions till they attained a proficiency score >90% on 3 consecutive scanning or maximum of 20 scans whichever was earlier.
showing the scoring card for the scanning assessments
Results Nineteen residents completed the study, of which13 (68%) reached 90% proficiency with a median number of 7 scanning sessions (IQR 6 – 9) (Figure 2). Learning curves for individual element identification showed C5,6,7 ventral rami, upper and middle trunk were easily learnt when compared to the C8, T1 ventral rami and inferior trunk (Figure 3). Overall,the number of scanning sessions required to attain cognitive skills were lesser 4 (2–6) when compared to the psychomotor skills 6 (IQR 4–8 ; P=0.002).
Conclusions Anaesthesiology residents required 7 scanning sessions to identify individual brachial plexus elements above the clavicle using SSBST. Identification of C8,T1 ventral rami and inferior trunk pose significant challenge in overall learning curve.