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Ultrasound-guided regional anesthesia: feasibility and effectiveness of teaching via telesimulation in Ethiopia
  1. Monica Liu1,
  2. Margaret Salmon2,
  3. Rene Zaidi3,
  4. Arun Nagdev4,
  5. Finot Debebe5,
  6. Mundenga Furaha Muller6,
  7. Cito Furaha Ruhangaza6,
  8. Haimanot Emiru5,
  9. Yonas Belachew5,
  10. Aklilu Tumebo5,
  11. Marcus Paoletti7,
  12. Allan Okrainec8,
  13. Vincent Chan1 and
  14. Ahtsham U Niazi1
  1. 1Department of Anesthesia, Toronto Western Hospital, Toronto, Ontario, Canada
  2. 2InnovationsCZ, San Francisco, California, USA
  3. 3InnovationsCZ, Goma, Congo (the Democratic Republic of the)
  4. 4Emergency Department, Alameda County Medical Center, Oakland, California, USA
  5. 5Emergency Department, Black Lion Hospital, Addis Ababa, Oromia, Ethiopia
  6. 6Department of Orthopedics, HEAL Africa Hospital, Goma, Congo (the Democratic Republic of the)
  7. 7UC Berkeley, Berkeley, California, USA
  8. 8Department of General Surgery, Toronto Western Hospital, Toronto, Ontario, Canada
  1. Correspondence to Ahtsham U Niazi, Anesthesia, Toronto Western Hospital, Toronto, ON M5T 2S8, Canada; ahtsham.niazi{at}


Background Acute pain management in resource-poor countries remains a challenge. Ultrasound-guided regional anesthesia is a cost-effective way of delivering analgesia in these settings. However, for financial and logistical reasons, educational workshops are inaccessible to many physicians in these environments. Telesimulation provides a way of teaching across distance by using simulators and video-conferencing software to connect instructors and students worldwide. We conducted a prospective study to determine the feasibility of ultrasound-guided regional anesthesia teaching via telesimulation in Ethiopia.

Methods Eighteen Ethiopian orthopedic and emergency medicine house staff participated in telesimulation teaching of ultrasound-guided femoral nerve block. This consisted of four 90-min sessions, once per week. Week 1 consisted of a precourse test and a presentation on aspects of performing a femoral nerve block, weeks 2 and 3 were live teaching sessions on scanning and needling techniques, and in week 4, the house staff undertook a postcourse test. All participants were assessed using a validated Global Rating Scale and Checklist.

Results Participants were provided with a validated checklist and global rating scale as a pretest and post-test. The participants showed significant improvement in their test scores, from a total mean of 51% in the pretest to 84% in their post-test.

Conclusions Teaching ultrasound-guided regional anesthesia of the femoral nerve remotely via telesimulation is feasible. Telesimulation can greatly improve the accessibility of ultrasound-guided regional anesthesia teaching to physicians in remote areas.

  • lower extremity
  • regional anesthesia
  • education
  • ultrasonography

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  • Contributors ML helped in protocol development, conduct of study, data analysis, and preparation of manuscript. MS and AUN helped in protocol development, conduct of study, data analysis, preparation of manuscript, and review of manuscript. RZ, FD, MFM, CFR, HE, AT, and YB helped in protocol development and conduct of the study. AN and MP helped in data analysis and preparation of manuscript. AO and VC helped in protocol development and review of manuscript.

  • Funding This study was funded by Education Development Fund, Faculty of Medicine, University of Toronto.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.