Ergonomic Consideration of Ultrasound-guided Transversus Abdominis Plane Block between Experienced and Novice Anaesthesiologists

Abstract

Introduction: Ergonomics is the science of interaction between human and working environment. The growing use of Ultrasound (US) in regional anaesthesia has created the need to consider ergonomic aspects relevant to regional anaesthesia. Aim: To analyse ergonomic consideration of Ultrasound-guided (USG) Transversus Abdominis Plane block (TAP) between experienced and novice anaesthesiologists for Inguinal Hernia Repair. Materials and Methods: A prospective observational study was conducted where 10 experienced (E) (performed >20 TAP block procedures) and 11 novice (N) (performed at least 5 TAP block procedures) anaesthesiologists participated. The study included 21 patients of ASA I and II posted for inguinal hernia repair under spinal anaesthesia. USG TAP block was given after the completion of surgical procedure. Patient, operator and environmental factors were observed and measured using a measuring scale and photographs and goniometer. Results: Performance of USG TAP block was ergonomically suboptimal and varied among the operators. A 7E and 2N performed the procedure in sitting position and others in standing position, which was statistically significant (p=0.03) adjustment of tables were done by 7E and 2N operators, the difference statistically significant (p=0.03). A 2E and 8N flexed their back and 7E kept their neck flexed less than 20° and 9N kept their neck flexed more than 20° which was statistically significant (p=0.001). Only 10E and 5N kept Ultrasound machine in front in line and others were not, which was statistically significant (p=0.012). There was no significant difference between the groups in terms of side of the block performed, location of the procedure, position of assistants and trolleys in relation to operator during the procedure. Conclusion: It was found that the performance of USG TAP block was ergonomically sub-optimal in the setting described. compared to novice, experienced operators performed better. Inclusion of ergonomic concepts in academic training