Background and Aims Ultrasound guided peripheral nerve blocks (USG-PNBs) have many benefits in a high burden low resource settings. These range from reduced airway related complications to decreased need for opioid analgesics. Barriers to performing USG-PNBs tend to surround education agnd equipment accessibility. At Queen Elizabeth Central Hospital, Malawi, there was access to ultrasound equipment and a learning cohort of over 30 anaesthetic trainee providers. As visiting anaesthetists to Malawi, our aim was to explore the delivery of USG-PNBs within this clinical setting.
Methods An assessment of current practice for performing USG-PNBs in theatres was carried out. This involved reviewing theatre workflow and stakeholder (surgical, recovery, and anaesthetic providers) discussions. Following this, practical teaching and supervision sessions were provided. This included the consent process, anatomy revision using free apps, scanning and needling techniques and safe use of local anaesthetics.
Results We found that stakeholders were receptive to USG-PNB use. Concerns raised included delays to theatre lists and desire for trainee supervision. Collaboration with surgeons and flexibility in timing of blocks increased the delivery of PNBs. Some trainees had received previous teaching, as such, we focused on technique and building confidence. Over a 2-month period, 20 lower limb,14 upper limb and 10 abdominal plane blocks were performed by physician and clinical officer trainees (figure 1).
Conclusions The use of USG-PNBs was well received by surgical and anaesthetic providers. We found a flexible supervisory approach enhanced the opportunities. A follow up study will need to be carried out to address issues of sustainability and skill retention.
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