Ultrasound Guided Peripheral Nerve Block Workshop: How to Take Your Residents from Zero to Hero
Correspondence should be addressed to Ashley Foreman, MD at aforema3@gmail.com
DOI: https://doi.org/10.21980/J8.52156
ABSTRACT:
Audience:
Emergency medicine residents of all years of training
Introduction:
Ultrasound guided peripheral nerve blocks (USGPNBs) provide adequate analgesic management by targeting specific nerves while limiting systemic effects.1,2 Utilizing this form of analgesia can decrease the use of procedural sedation and/or systemic pain management, which can pose inherent risks such as need for continuous monitoring and airway compromise.1 Nerve blocks require both training and specialized equipment to perform. This workshop aimed to evaluate resident comfort and familiarity with these blocks before and after completing specialized training sessions focusing on serratus anterior, posterior tibial, median, ulnar, and radial USGPNB. Ultrasound training for most residents is a longitudinal experience that often includes dedicated ultrasound scanning shifts and encouragement to include ultrasound into daily practice, however, the utility of ultrasound workshops in teaching nerve blocks has up until this point been explored very little and therefore under-utilized.
Educational Objectives:
After completing this small group workshop, the resident should be able to: 1) recognize the indications for the serratus anterior plane block, the posterior tibial block and the ulnar, median, and radial nerve blocks and the anatomical locations that would benefit from these blocks, 2) identify proper probe selection and placement, in addition to patient positioning, in order to perform these blocks, as well as anesthetic choice and dosing, 3) demonstrate knowledge of anatomical landmarks and areas to avoid evidenced by probe placement and positioning, 4) describe the steps to perform these nerve blocks, and 5) demonstrate knowledge of contraindications to these blocks as well as potential complications of these procedures and how to mitigate them.
Educational Methods:
This workshop was held in a small group format that was set up in multiple stations. Each station started with a short didactic presentation followed by USGPNB simulation on standardized patients.
Research Methods:
Pre-workshop surveys were conducted via Qualtrics to assess familiarity with the indications and mechanics for conducting UGPNBs. Following the workshop, the survey was repeated as a post-workshop assessment, where residents were given the opportunity to assess their comfort with the indications for these blocks and their confidence in the steps taken to perform them. They also gave feedback on the workshop design and content.
Results:
Overall, residents reported more comfort with these blocks based on survey results. Pre-workshop survey responses contained widespread levels of comfort in all aspects of these blocks including knowledge pertaining to indications, probe selection, anatomical regions that would benefit from anesthetic, anatomical landmarks, areas to avoid, anesthetic choice, contraindications, and complications and their respective management. Following the workshop, all participants voiced increased knowledge and confidence, answering that they somewhat or strongly agreed with comfortability in all of the above areas 93-100% of the time.
Discussion:
Small group workshops that utilize standardized patients (SPs) and concise didactic presentations are effective ways to teach emergency medicine residents how to confidently perform UGPNBs.
Topics:
Nerve block, ultrasound, small group, workshop, resident, local anesthesia.
