"Whoosh" test as a teaching aid in caudal block

Area of Science:

• Anesthesiology
• Pediatric Medicine
• Medical Education

Background:

• Caudal epidural blocks are commonly used for minor gynecological procedures in pediatric patients.
• Traditional landmark-based techniques rely on tactile cues like 'give' and 'loss of resistance' for correct needle placement.
• Resident performance in caudal blocks can be variable, highlighting the need for improved teaching and assessment methods.

Purpose of the Study:

• To evaluate the efficacy of the 'whoosh' test as an adjunct for teaching caudal epidural anesthesia to residents.
• To compare the predictive value of the 'whoosh' test against traditional tactile methods ('give' and 'loss of resistance').

Main Methods:

• Fifty-three pediatric patients undergoing minor gynecological procedures received caudal blocks performed by residents.
• Residents utilized standard tactile techniques for needle placement.
• A supervising anesthesiologist independently assessed the 'whoosh' test by auscultating the thoracolumbar region during air injection into the caudal space.

Main Results:

• The 'whoosh' test demonstrated a high positive predictive value (97.7%) for correct caudal epidural needle placement.
• Positive predictive values for 'give' and 'loss of resistance' were 78% and 80.7%, respectively.
• An absent 'whoosh' test had a 100% negative predictive value, indicating accurate needle placement.

Conclusions:

• The 'whoosh' test is a highly reliable and accurate method for confirming correct caudal epidural needle placement.
• This auditory technique significantly enhances the teaching and learning of caudal anesthesia for resident physicians.
• The 'whoosh' test provides objective feedback, improving resident confidence and patient safety during caudal blocks.