Implementation of regional anesthesia education for emergency medicine residents and faculty

Using opioids for pain management in emergency departments (ED) poses risks such as respiratory depression and addiction. Ultrasound-guided regional anesthesia (UGRA) offers an alternative to opioids and procedural sedation, yet many emergency medicine (EM) residencies lack formal training for this skill. It is crucial to develop education initiatives aimed at incorporating UGRA techniques into clinical practice for emergency physicians (EPs).

A regional anesthesia education program for EM residents and faculty was piloted. The intervention comprised a 25-min video on safe UGRA practices followed by a 4-h hands-on course using cadaveric and live models. Participant knowledge was tested before the course and 6 weeks afterward. Test results were analyzed via paired t-test. The electronic health record was reviewed for UGRA blocks performed in the ED 2 months before and after the intervention. Efficacy was evaluated through patient-reported pain improvement and ultrasound image review. Immediate complications are reported.

Twenty-six residents and 11 faculty completed the video review, hands-on course, and the pre/posttests. With a maximum score of 30, median (IQR) pretest scores were 14 (12-17) and increased to 21 (18-23) 6 weeks postcourse, with a median 8 (95% CI 4.1-9.0) points improvement. One-hundred percent of participants found the training helpful. Clinical data were collected from August 26, 2023, to December 25, 2023, and the number of UGRA blocks performed rose from 55 before to 102 after the intervention. Pain improvement was similar before and after the intervention. Review of recorded images indicated proper needle position and anesthetic spread in 91% of blocks precourse and 82% postcourse.

This educational intervention increased UGRA blocks with few complications and a high success rate. Provider knowledge significantly improved, but needle positioning and anesthetic spread were inappropriate in 18% of blocks postcourse, emphasizing the need for ongoing education to enhance UGRA competency among EPs.