High Neuraxial Blockade in a Parturient After Epidural Placement: A Quality Improvement Simulation

Area of Science:

• Anesthesiology
• Medical Simulation
• Obstetrics

Background:

• Epidural anesthesia is common for labor pain but carries a risk of high neuraxial blockade.
• Recognizing and managing this complication is crucial for anesthesiology residency training.

Purpose of the Study:

• To evaluate a simulation-based training module for anesthesiology residents on managing high neuraxial blockade.
• To assess the impact of simulation on resident confidence in handling this obstetric complication.

Main Methods:

• A simulated case of high neuraxial blockade during labor epidural anesthesia was developed.
• Anesthesiology residents and student registered nurse anesthetists (SRNAs) participated in the simulation.
• Post-simulation surveys assessed participant comfort and learning via REDCap.

Main Results:

• Nine participants completed the pilot simulation, providing positive feedback on realism and training value.
• The simulation reinforced skills in endotracheal intubation, epidural placement, and managing unstable patients.
• Participants gained experience in recognizing and treating high neuraxial blockade.

Conclusions:

• Simulation-based training offers a controlled environment for practicing high-stakes anesthesiology scenarios.
• This simulation effectively improved skills for managing epidural anesthesia complications in obstetrics.
• The training is planned for annual integration into the anesthesiology residency curriculum.