グアテマラの資源不足環境における超音波ガイド下区域麻酔：ハイブリッドトレーニングモデルの将来予測評価

Ultrasound Guided Regional Anesthesia (UGRA) remains underutilized in low- and middle-income countries (LMICs) due to barriers to training and equipment. Recent advances in portable ultrasound (US) and international partnerships have expanded UGRA access, enhancing patient safety and quality of care.

This evaluation describes the development and outcomes of a hybrid UGRA training program for anesthesiologists at the Hospital Nacional de Coatepeque (HNC) in Guatemala.

An educational pilot program for UGRA was developed based on local needs and feedback, comprising four weeks of online modules, an in-person educational conference, and one month of supervised clinical practice. Evaluation followed the Kirkpatrick framework using pre- and post-program surveys adapted from the Global Regional Anesthesia Curricular Engagement (GRACE) model. Outcomes included participants' satisfaction, and change in knowledge and skill, and procedural performance. Knowledge and skill assessments were compared pre- and post-training, and clinical data were recorded for 10 months. Non-parametric tests were used to assess changes and associations with performance outcomes.

All seven anesthesiologists at HNC completed the training program. Knowledge test scores improved by a median percentage increase of 20.8% (5/24, IQR 13.5%-28.1%, r=0.899, P=.016), and clinical skill rating scores increased by a median percentage of 147.1% (1.8/5, IQR 96.9%-197.3%, r=0.904, P=.031) at 1 month and 131.4% (1.6/5, IQR 90.5%-172.3, r=0.909, P=.035) at 4 months post-program. Participants reported high satisfaction and significant perceived improvement and motivation. 54 PNBs were performed under direct supervision in the first month, with 187 blocks recorded over 10 months. The supraclavicular brachial plexus block was the most frequently utilized (66, 45%) and replaced the standard general anesthetic for upper extremity surgery in 70 patients. Procedure success rate was 96% (180/187) and there were no observed patient complications.

This hybrid curriculum enabled successful implementation of UGRA at a public hospital in Guatemala, safely expanding clinical capabilities and reducing reliance on general anesthesia for upper extremity surgery. This practical training model provides a framework for implementing UGRA in similar resource-limited hospitals.