Different Learning Curves for Axillary Brachial Plexus Block: Ultrasound Guidance versus Nerve Stimulation

Area of Science:

• Anesthesiology
• Medical Education
• Ultrasound Technology

Background:

• The learning curve for performing peripheral nerve blocks using ultrasound or nerve stimulation guidance is not well-established.
• Axillary brachial plexus block is a common procedure where guidance techniques can impact resident training and patient outcomes.

Purpose of the Study:

• To compare the learning curves of residents trained in ultrasound guidance versus nerve stimulation guidance for axillary brachial plexus blocks.
• To determine which guidance technique facilitates faster skill acquisition and leads to a higher success rate in novice practitioners.

Main Methods:

• Ten anesthesiology residents with no prior ultrasound experience received ultrasound training.
• Ten anesthesiology residents with no prior nerve stimulator experience received nerve stimulator training.
• Learning curves were generated via retrospective analysis of electronic anesthesia records, with success rates pooled and analyzed using bootstrapping and Monte Carlo simulation.

Main Results:

• Residents trained in ultrasound guidance demonstrated a faster learning curve for axillary brachial plexus blocks.
• Ultrasound-guided blocks resulted in a higher final success rate compared to nerve stimulator-guided blocks.
• Novice practitioners can achieve proficiency more efficiently with ultrasound guidance.

Conclusions:

• Ultrasound guidance is a more efficient method for learning axillary brachial plexus blocks compared to nerve stimulator guidance.
• Training programs can benefit from incorporating ultrasound guidance to improve resident proficiency and patient care in regional anesthesia.