Ultrasound Guided Regional Anesthesia and Simulation

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Problem: Literature regarding the number of iterations required for a nurse anesthetist graduate student to become proficient in ultrasound guided regional anesthesia is scare. Objectives: This pilot study aims to quantify the number of iterations and the amount of time required to reach a level of proficiency to identify the interscalene brachial plexus nerve bundle under ultrasound guidance. Design: A repeated measures design with a pretest-posttest methodology was used on a convenience sample of second year nurse anesthetist graduate students. A pretest was conducted followed by an educational component and five posttest iterations. The educational component included a lecture and hands on demonstrations on how to locate the interscalene brachial plexus nerve bundle. Each interations was analyzed for accuracy and timing. A posttest survey was given to the participants to assess student satisfaction. Results: The rate of accurate identifications of the interscalene brachial plexus nerve bundle increased from 16.67% during the pretest to 83.33% at the end of the fifth posttest iteration. An average of 1.83 iterations were required to accurately identify the interscalene brachial plexus nerve bundle. The average time taken to accurately identify the interscalene brachial plexus nerve bundle was 1 minute 19 seconds. The average time to first correct response was 1 minute 24 seconds. The average rate of accuracy for participants over six iterations was 53%. Eighty-three percent of participants strong agreed and 17% of participants agreed that they felt confident in their ability to perform the interscalene brachial plexus block. All participants agreed that the ultrasound guided regional anesthesia project was beneficial and provided knowledge of the anatomy of the interscalene brachial plexus nerve bundle. Validity of the survey and protocol was assessed by face validity. Significance: The project demonstrates a proof of concept of combining an educational presentation with repetitive simulation education in developing proficiency to identify the interscalene brachial plexus nerve bundle under ultrasound guidance. It also provides the nurse anesthesia program at the University of Buffalo evidence based information for future ultrasound guided regional anesthesia training activities. Lastly, it adds to the growing body of knowledge related to ultrasound guided regional anesthesia.