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Simulated-based training for ultrasound-guided popliteal sciatic nerve block: determining the learning curve and
Pablo F Miranda1, Andrea L Araneda1, Natalia P Molina1
1División de Anestesiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, 8330024, Chile.
Background:
The following study aims to determine the learning curve experienced by anesthesia residents when training for an ultrasound-guided popliteal sciatic block and the transference of this training to real patient situations.
Methods:
After approval by the ethics committee, eleven first-year anesthesia residents were recruited to participate in a simulation-based training program to perform a single shot in plane popliteal sciatic block. Training consisted of 10 individual sessions, with direct feedback from the instructor, with a specific Laerdal® popliteal sciatic block phantom, lasting one hour and distributed weekly. At the end of each session, the resident's performance was assessed. Residents were videotaped while performing the block, which was to be evaluated using a validated global rating scale (GRS). Additionally, a tracking motion device attached to the operator's hands (Imperial College Surgical Assessment Device, ICSAD) recorded the total distance traveled by both hands (Total path length, TPL), number of movements (NM), and total procedure time (TPT). One week later, the same assessment was done on a real patient.
Results:
Ten residents completed the training and the assessments. Median values of GRS scores significantly improved from 15 to 28.3 through the training (p = 0.006). Regarding ICSAD scores, TPT improved from 126 to 63.4 s (p = 0.002), and TPL improved from 11.07 to 9.4 m (p = 0.322). When comparing the last simulated session and the subsequent measurement in an actual patient, median values of GRS, TPL and NM were not different.
Conclusions:
This simulation-based training program significantly improved residents' proficiency in an ultrasound-guided popliteal sciatic block. The learning curve plateaued at session 7, and this improvement was transferred to the real patient setting. As expected, residents needed more time for the first block on a real patient than for the last simulated session.
Clinical Trial Number:
ClinicalTrials.gov, identifier NCT06081790.
