334 Teachability of the Ultrasound-Guided Erector Spinae Plane Block to Emergency Physicians

Abstract

The ultrasound-guided erector spinae plane block (USG-ESPB) was first described in 2016 by anesthesiologists for thoracic neuropathy in the perioperative setting; it was recently cited as an easy-to-learn, safe, and efficacious emergency department (ED) analgesic modality; however, the literature is limited to case reports and small sample sized studies. The ubiquity of US-guided nerve blocks in the ED highlights emergency physicians (EPs) as ideal candidates to learn the USG-ESPB. To date, no study has described the teachability of the USG-ESPB to EPs. This study evaluates the teachability of USG-ESPB through a structured instructor-led cadaveric workshop. All levels of EPs were eligible to participate in the study. The workshop instructor was a dual board-certified emergency medicine and pain medicine physician. The 3-hour course consisted of a pre-workshop video, 30-minute lecture, hands-on cadaver demonstration, and procedural rehearsal time with intermittent procedural evaluation. A pre-workshop, post-workshop and 4-week follow-up survey were used to assess participants’ confidence of various aspects of the USG-ESPB. Procedural task proficiency was evaluated via direct observation by the instructor using a critical action checklist. The various aspects of the USG-ESPB were grouped into three stages: pre-procedural knowledge (indications, informed consent, sterile preparation), procedural technique (sonoanatomy identification, needle work) and post-procedural knowledge (monitoring for complications). Proficiency of each stage was defined as a perfect score for all tasks related the respective stage. IRB determined this study was not subject to review. Seven EPs participated in the workshop spanning intern to fellowship trained attendings; six follow-up surveys were collected. Participant confidence in pre-procedural knowledge and procedural technique increased across all surveys. Pre-procedural knowledge and post-procedural knowledge demonstrated significant confidence increases from the pre-workshop to post-workshop surveys (p<0.01 and p<0.05, respectively; Figure 1A). Notably, confidence in post-procedural knowledge decreased in the follow-up survey. Proficiency in pre-procedural and post-procedural knowledge was achieved by 100% of participants by six attempts and five attempts, respectively; proficiency in procedural technique was reached by 85.7% of participants by six attempts, one participant never reached proficiency (Figures 1B). Follow-up data highlighted the barriers to implementing USG-ESPB into clinical practice – these included low census of patients for the block used in the thoracic area (100%), no beds/personnel available for procedural monitoring (66.7%), time spent gathering supplies (50%), low confidence in procedural technique (50%), and no supervising expert (50%). A 3-hour workshop consisting of a lecture, demonstration, and cadaveric procedural rehearsal is a viable method of teaching the USG-ESPB to EPs. Self-confidence in USG-ESPB in all procedural stages increased across most study surveys. Evaluations of procedural proficiency suggests six procedural rehearsals is the minimum to achieve proficiency by the majority of EP learners. Most participants cited census for the thoracic EPSB and equipment/personnel availability as barriers to implementing USG-ESPB into EP clinical practice.