Related Experiment Video
Updated: May 24, 2025
Author Spotlight: Enhancing Success of Ultrasound-Guided Neuraxial Anesthesia in Cases with Difficult Anatomy
Published on: January 31, 2025
Comparison of the Learning Curves of Ultrasound-Guided In-Plane Needle Placement Among Four Different Puncture Modes:
Yingjie Hu1, Jing Xiao1, Xiao He1
1From the Department of Anesthesiology and Pain Medicine, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, and Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Background:
The effects of different positional relationships between the probe, needle, and puncture model on in-plane puncture performance have not been fully evaluated. In this simulation study, we used a 4-period crossover design to compare the learning curves of ultrasound-guided in-plane needle placement among 4 different puncture modes by novices.
Methods:
Forty residents were randomly assigned to receive training in one of 4 puncture modes according to the placement of the puncture model and the orientation of the probe to the operator: horizontal phantom-parallel probe (HP), horizontal phantom-vertical probe (HV), vertical phantom-parallel probe (VP), and vertical phantom-vertical probe (VV). They were allowed 10 trials on each mode and then received the other 3 trainings following the predefined sequences based on a Williams design. Puncture time was recorded from needle entry until successful in-plane puncture under ultrasound guidance.
Results:
Linear and generalized linear models indicated significant effects of puncture mode and trial number on puncture time ( P < .001 for all models). The mean (standard deviation [SD]) puncture times for 10 trials were 44 (44) s for HP, 37 (34) s for HV, 80 (57) s for VP, and 46 (48) s for VV. HV had the shortest puncture time, while VP had the longest. No significant difference was observed in puncture time between VV and HP modes ( P = .330). Within each mode, puncture time significantly decreased from the first to the tenth trial ( P = .001 for HP, P < .001 for HV, P < .001 for VP, and P = .002 for VV). VP showed the steepest learning curve; however, even after 10 trials, its puncture time remained significantly higher than that of the other 3 modes ( P < .001 for all comparisons).
Conclusions:
Ultrasound-guided in-plane puncture difficulty follows the order VP > HP = VV > HV.
