Neuraxial Blockade Research Articles

Off Side! A Simple Modification to the Parasagittal In-Plane Approach for Paravertebral Block

The use of thoracic paravertebral blocks (PVBs) for breast cancer surgery confers important analgesic benefits. Several ultrasound (US)-guided PVB approaches have been described, but still elusive is the ideal technique that (1) permits continuous visualization of the entire needle shaft and tip, (2) avoids aiming the needle tip and injectate directly toward the neuraxis, and (3) is easy to perform. Although the parasagittal view in-plane PVB approach satisfies the former 2 criteria, maneuvering the needle to reach the targeted paravertebral space can be difficult as its trajectory is often obstructed by the bony transverse processes. This brief technical report describes the "off-side" technique--a simple solution to the technical challenge posed by the double-fulcrum effect exerted first by the transducer and then by the adjacent inferior transverse process. Our "off-side" technique marks a departure from conventional US-guided regional anesthesia teaching that recommends positioning the target in the middle of the US field and may be useful in similar types of US-guided regional anesthesia procedures such as neuraxial blockade.

Blood Conservation

Blood Conservation

A comparative study evaluating the prophylactic efficacy of oral clonidine and tramadol for perioperative shivering in geriatric patients undergoing transurethral resection of prostate.

Background and Aims:Perioperative shivering, in geriatric patients undergoing urological surgery under central neuraxial blockade is a common complication. Prophylactic measures to reduce shivering are quintessential to decrease the morbidity and mortality. Believing that oral formulation will bring down the cost of treatment, we decided to compare the efficacy of oral clonidine and tramadol, as premedication, in prevention of shivering in patients undergoing transurethral resection of prostate (TURP) under spinal anesthesia in a prospective and double-blind manner.Materials and Methods:The patients were randomly allocated into three groups (40 patients each). Group I received oral clonidine 150 μg, Group II received oral tramadol 50 mg, while Group III received a placebo. Number of patients having shivering, their grades and duration, hemodynamic changes, and side-effects in the form of sedation were recorded. Data were analyzed using analysis of variance, Student's t-test, Z test as and when appropriate.Results:In group I and II, 38 patients (95%) and 37 patients (92.5%) did not shiver, respectively. Although in the group III, 24 patients (60%) exhibited no grade of shivering, the shivering was of significantly severe intensity and lasted for a longer duration. No, clinically significant collateral effects were observed in patients who were administered clonidine or tramadol.Conclusions:Oral clonidine and tramadol were comparable in respect to their effect in decreasing the incidence, intensity, and duration of shivering when used prophylactically in patients who underwent TURP under subarachnoid blockade.

Management of ankylosing spondylitis case for ankle surgery under spinal anaesthesia by Taylor’s approach

Managing a case of ankylosing spondylitis can be difficult and challenging as both airway and vertebral column are deformed yet difficult and associated with extra articular manifestation. Taylor's approach can be considered ideally in these patients coming for lower limb surgeries. We present a young patient with severe ankylosing spondylitis with cardiac and pulmonary involvement coming for ankle surgery where we used Taylor's approach for successful central neuraxial blockade. By this approach the case was managed perioperatively optimally and safely.

Prophylactic vs. therapeutic magnesium sulfate for shivering during spinal anesthesia

IntroductionShivering is one of the most common complications of neuraxial blockade. Some patients find shivering sensation worse than surgical pain. Therefore, both prevention and treatment of established shivering should be regarded as clinically relevant intervention in the perioperative period. The aim of our study is to compare the efficacy of magnesium sulfate when used for prevention or treatment of shivering following spinal anesthesia.MethodsIn this prospective, double blind, placebo controlled study, 120 ASA I, II patients undergoing surgery under spinal anesthesia were randomized into 3 groups. Following intrathecal injection, Group P (prophylactic) was given MgSO4, 50 mg/kg I.V. bolus + 2 mg/kg/h infusion. Group T (therapeutic) was given MgSO4 50 mg/kg I.V. bolus as a therapy when shivering occurred. If shivering persisted, they received 25 mg/kg I.V. bolus. Group C (control) received saline at identical times. Meperidine was given as rescue if shivering persisted. Shivering grade 3/4 was regarded as significant. Core temperatures, incidence of shivering, and side effects were recorded.Main resultsTotal incidence of shivering, grade 3/4, was 15% in Group P, 45% in Group T, and 50% in Group C (p < 0.01). Magnesium sulfate significantly reduced the incidence and gain of shivering. The use of rescue meperidine was more in Group P (20%) and Group C (50%) compared to none in Group T (p < 0.05, p < 0.01, respectively). Significant reduction in core temperature occurred in the Mg groups compared to the control group p < 0.05. No correlation was found between patients who shivered and core temperature or ΔT. Hypotension was more frequent in Group P; nausea and vomiting were more in Mg groups than control group p < 0.05.ConclusionFollowing spinal anesthesia, prophylactic MgSO4 infusion lowered incidence of shivering. When shivering did occur, MgSO4 proved to be an effective treatment with minimal side effects.

Caudal Anesthesia through Drilling Hole on Sacral Hiatus: A Case Report

A 40 (forty) year old male patient with Ankylosing Spondylitis was admitted for total replacement of left hip joint. Fusion of the axial skeleton, immobility of cervical spines and restricted movement of temporo- mandibular joint lead to anticipate difficulty in intubation and failure of central neuraxial blockade for total hip replacement. Above factors also compelled to discard the attempts for spinal or epidural or general anesthesia (G.A.) in the conventional way. Last of all, it was decided to operate under caudal anesthesia. But it was difficult to administer caudal anesthesia through calcified sacral hiatus. After through discussion with surgeons, decision was taken to drill the calcified membrane over the sacral hiatus. Through the drilling hole, nerve stimulator needle was introduced and 30 ml of local anesthetic was injected in sacral epidural space after electing dorsiflexion moment of great toe. Satisfied anesthesia developed within 5 minutes. At last, an epidural catheter was inserted within sacral epidural space and kept it left in the sacral epidural space. Operation was completed smoothly without any disturbance from patient's side. No hemodynamic instability was noted. Keywords: axial skeleton, cervical spines, blind nasal intubation, awake fiber optic intubation, peripheral nerve block, psoas compartment, nerve stimulator I. Introduction Airway management is the essential and topmost important component of general anesthesia and major responsibility of anesthesiologist during and after operation. For maintaining an intact functional airway and also for ventilating the anaesthetized patient, several techniques are advocated. Among those, endotracheal intubation achieved top most priority in airway management and also in ventilating the patient either for short term or long term procedure. Awake nasal intubation or fiber optic intubation is useful at the time of failed intubation or anticipated difficult intubation or at the time of failure of maintaining airway integrity and restoration of functional airway patency with mask ventilation. Laryngeal mask airway or intubating laryngeal mask airway is also useful to establish an airway patency of the patient in above purposes and also to avoid the pulmonary aspiration and pressure damage of the eye. But in emergency, this device (L.M.A.) is very much important life saving procedure for patent airway management to ventilate the anaesthetized patient. Ankylosing Spondylitis is always problematic and challenging case to anesthesiologist to anaesthetize the patient for their surgeries. In advanced form of Ankylosing Spondylitis, involvement of axial skeleton provides impracticability of central neuraxial procedure. The involvement of temporo-mandibular joint and fusion of cervical spine make the condition worst for intubation and general anesthesia become impossible without awake nasal or fiberoptic intubation. But both are troublesome, injurious and painful procedure without acceptance of patient. The Psoas compartment block with sciatic nerve block may form an alternative option to anesthetize. But its' reliability for major operation is doubtful. The sacral spinal anesthesia 1 or sacral epidural anesthesia 2 through its foramen is anticipated to be impossible due to obliteration of dorsal foramen of sacrum. For the above causes, decision was taken to anesthetize the patient with caudal anesthesia through the drilling hole on the sacral hiatus.

Pain Management Strategies for Thoracotomy and Thoracic Pain Syndromes

Pain after thoracic surgery can be severe and, in the acute phase, contribute to perioperative morbidity and mortality. Unfortunately, patients also incur a significant risk of chronic pain. Although there are guidelines for postoperative pain management in these patients, there is no widespread surgical or anesthetic "best practice." Here, we review the recent literature on techniques specific to perioperative pain control for thoracic patients, including medical management, neuraxial blockade, and other regional techniques, and suggest an algorithm for developing a multimodal pain management strategy.

Incidencia de complicaciones neurológicas y cefalea pospunción dural luego de anestesia regional en la práctica obstétrica: un estudio retrospectivo de 2399 pacientes

Introduction and objectivesRegional anesthesia provides excellent anesthesia and analgesia in obstetric patients, but has potential for complications such as post-dural puncture headache and permanent or transient nerve damage. This study aimed to describe the incidence of post-dural puncture headache and nerve damage in the obstetric population of auniversity hospital that was submitted to neuraxial blockades, comparing with the world literature, and identify risk factors. Materials and methodsA retrospective cohort was performed including data collected in the records of post-anesthetic consults conducted during the year 2010. The main analysis was performed on the complaints of peripheral neurological deficits and headaches reported by patients, type of anesthesia and performed surgical procedures. A multiple regression analysis was performed to investigate the association between the onset of lower limb paresthesias and the length of stay of these patients in the gynecological position and other variables. ResultsA total of 2399 pregnant patients who had undergone neuraxial blockade were evaluated. Neurologic complications that occurred in these patients were divided into lower limb paresthesias (0.3%), transient radicular irritation (0.1%), and post-dural puncture headache (3%). The patients who stayed more than 60 min in gynecological position showed an odds ratio of evolution with lower limb paresthesias of 1.75 and patients who stayed more than 120 min showed an odds ratio of 2.1, but without statistical significance. ConclusionsPatients submitted to neuraxial blockades and placed in gynecological position were more likely to evolve with lower limb paresthesias related to duration of this position.

Remote intrathecal morphine preconditioning is ineffective in the presence of neuraxial blockade with lidocaine

Remote intrathecal morphine preconditioning (RMPC) induces cardioprotection via a neural pathway. Intrathecal lidocaine (LID) blocks spinal cord nerve transmission. This study examine whether LID prevents the effects of RMPC. Anesthetized, open chest, male Sprague-Dawley rats were assigned to one of seven treatment groups 3 days after intrathecal catheter placement. Rats from both RMPC and LID groups, respectively, received intrathecal morphine (3 μg/kg) and lidocaine (1%, 10 μL); morphine was administered by three cycles of 5-minute infusions interspersed with 5-minute infusion-free periods. The LID + RMPC group received the combination of LID and RMPC. Intrathecal naloxone methiodide (NM) (20 μg/kg) was administered either 15 minutes before RMPC, or 5 minutes before LID + RMPC. Ischemia and reperfusion injury were then induced by 30 minutes of left coronary artery occlusion, followed by 120 minutes of reperfusion. Infarct size, as a percentage of the area at risk (AAR), was determined by 2,3,5-triphenyltetrazolium staining. The RMPC and LID groups markedly reduced the infarct size (IS) compared with controls. LID prevented the effect of RMPC. NM had no effect on control and LID + RMPC treatments. However, NM pretreatment reversed cardioprotection of RMPC treatment. Intrathecal morphine preconditioning is ineffective in the presence of neuraxial blockade with lidocaine.

Incidence of neurological complications and post-dural puncture headache after regional anesthesia in obstetric practice: A retrospective study of 2399 patients

Introduction and objectivesRegional anesthesia provides excellent anesthesia and analgesia in obstetric patients, but has potential for complications such as post-dural puncture headache and permanent or transient nerve damage. This study aimed to describe the incidence of post-dural puncture headache and nerve damage in the obstetric population of a university hospital that was submitted to neuraxial blockades, comparing with the world literature, and identify risk factors. Materials and methodsA retrospective cohort was performed including data collected in the records of post-anesthetic consults conducted during the year 2010. The main analysis was performed on the complaints of peripheral neurological deficits and headaches reported by patients, type of anesthesia and performed surgical procedures. A multiple regression analysis was performed to investigate the association between the onset of lower limb paresthesias and the length of stay of these patients in the gynecological position and other variables. ResultsA total of 2399 pregnant patients who had undergone neuraxial blockade were evaluated. Neurologic complications that occurred in these patients were divided into lower limb paresthesias (0.3%), transient radicular irritation (0.1%), and post-dural puncture headache (3%). The patients who stayed more than 60min in gynecological position showed an odds ratio of evolution with lower limb paresthesias of 1.75 and patients who stayed more than 120min showed an odds ratio of 2.1, but without statistical significance. ConclusionsPatients submitted to neuraxial blockades and placed in gynecological position were more likely to evolve with lower limb paresthesias related to duration of this position.

Beyond the caudal

To discuss and compare the more commonly used truncal blocks with neuraxial techniques in children undergoing a variety of thoracic, abdominal and urological procedures. Owing to the advent of ultrasonography and its increasing use in regional anesthesia, there has been a renewed interest in implementing these techniques in children for intraoperative and postoperative pain management. The use of regional anesthesia particularly with ultrasound guidance is an integral part of pain management during the intraoperative and postoperative period in children who undergo surgery. Its use is essential in improving patient pain control and overall satisfaction as well as decreasing hospital stay and reducing hospital admission after surgery. Truncal blocks serve as an excellent alternative to neuraxial blockade, in patients who have a contraindication to neuraxial blockade, patients undergoing a unilateral procedure and those in an outpatient ambulatory setting undergoing routine procedures, wherein the adverse effects of neuraxial blockade such as motor weakness, difficulty ambulating, urinary retention, increased nausea and vomiting, may delay same day discharge.

Effect of an Anaesthesia Information Video on Preoperative Maternal Anxiety and Postoperative Satisfaction in Elective Caesarean Section: A Prospective Randomised Trial

Video-based patient information supplementing clinician interview has been shown to reduce anxiety and improve satisfaction in patients undergoing procedures. In Queensland more than 90% of caesarean sections are performed under regional anaesthesia. We aimed to assess the effect of using an information video about neuraxial blockade in patients having regional anaesthesia for elective caesarean section. Subjects were randomised to undergo usual care (Group C), or to view a video and undergo usual care (Group V). Subjects completed the Spielberger State-Trait Anxiety Inventory preoperatively and the Maternal Satisfaction with Caesarean Section Score questionnaire postoperatively. Satisfaction with, and duration of the preoperative anaesthetic interview, were noted. One-way analysis of variance (ANOVA) and Chi-squared tests were used in statistical analysis. One-hundred and forty three subjects were randomised and 110 completed the protocol and analysis. Group C and Group V were similar in terms demographic and anaesthesia data. There was no difference in anxiety score (41.2 versus 39.8, P=0.50), maternal satisfaction score (118.5 versus 122.7, P=0.22) or interview duration (16.3 versus 15.8 min, P=0.69) between the two groups. The use of an anaesthesia information video does not reduce preoperative anxiety or increase the duration of the anaesthetic interview. Maternal satisfaction with neuraxial blockade for elective caesarean is high and not improved by an anaesthesia information video.

A randomized controlled trial of preinsertion ultrasound guidance for spinal anaesthesia in pregnancy: outcomes among obese and lean parturients

The present study was conducted to examine if preinsertion lumbar ultrasound scanning helps with performance of spinal puncture, as a tool for decreasing the number of puncture attempts and spinal procedure time and increasing the success rate. We hypothesized that ultrasound can facilitate neuraxial blockade, particularly in pregnant women with difficult topographic anatomy. One hundred (50 lean, BMI <30kg/m(2), and 50 obese, BMI ≥30kg/m(2)) parturients scheduled for cesarean delivery were divided into ultrasound and control groups. Subarachnoid block was performed with prepuncture ultrasound examination in lean parturients (group 1, n=25) and in obese parturients (group 2, n=25), and subarachnoid block was performed without prepuncture ultrasound examination in lean parturients (group 3, n=25) and in obese parturients (group 4, n=25). The number of puncture attempts and puncture levels were recorded. A lower number of puncture attempts and fewer puncture levels were detected in ultrasound (US) groups (p<0.001). First attempt success rate under US guidance was 92% in comparison to 44% using a conventional technique in obese parturients (p<0.001). In 52% of the lean patients and in 54.2% of the obese patients, the intercristal line was at the L3-L4 and at the L2-L3 interspace, respectively. The duration of spinal procedure was shorter in US groups (22 vs. 52s, p=0.031). We found a high correlation between ultrasound and needle depth (r=0.709, p<0.001). We found a high level of success in the prepuncture ultrasound-determined insertion point. The ultrasound imaging technique can be a reliable guide to facilitate spinal anesthesia, especially in obese parturients.

In Reply

Drs. Slater and Lerner have reemphasized a critical point in our published case scenario1: Standard coagulation tests are inadequate in assessing adequacy of platelet function for epidural catheterization. Therefore, we recommended in our algorithm presented in figure 4 of our original report1 to use whole blood multiple electrode impedance aggregometry (Multiplate®; Roche Diagnostics, Mannheim, Germany) or whole blood turbidimetric aggregometry (VerifyNow®; Accumetrics, San Diego, CA) to support decision making in patients with antiplatelet therapy.1 Multiple electrode impedance aggregometry and VerifyNow® have been used to assess the efficacy of antiplatelet drugs and the dynamics of platelet function recovery after clopidogrel treatment—also under the scenario “risk–benefit analysis of neuraxial blockade.”2–7 Multiple electrode impedance aggregometry is as sensitive as light transmission aggregometry (Born aggregometry—the definitive standard of platelet function analysis) to detect platelet dysfunction,8,9 predict stent thrombosis and bleeding rates after coronary interventions,2,10 and can be used as a guide to support treatment of hemorrhagic patients undergoing cardiac surgery.11,12Please note that the value of thromboelastography or thromboelastometry in our case scenario relates to detection of trauma-induced coagulopathy with reduced clot firmness13 and hypercoagulability due to an acute phase reaction with high plasma fibrinogen concentrations, which we know occurs frequently after the acute phase of trauma-induced coagulopathy.14,15Dr. Flores suggests the use of multilevel continuous intercostal nerve block catheter in a patient with flail chest. Although the risk of epidural hematoma may be lower with intercostal nerve blocks compared with epidural analgesia, other risks such as pneumothorax/hematothorax and inadequate efficacy may limit its use under the condition described in our case scenario.We need to develop specific outcome-oriented clinical pathways in critical care medicine that do not exclusively take into account the data taken from elective surgical procedures in the operating room. In patients with flail chest presenting with traditional contraindications for neuraxial analgesia, careful risk–benefit analysis may indicate that epidural analgesia improves important outcome measures. We believe that thromboelastography or thromboelastometry and aggregometry (if available) are helpful instruments for decision support in such a case scenario.

Ultrasound for Central Neuraxial Blockade

The evidence base supporting the role of ultrasound to assist the performance of neuraxial anesthesia has become increasingly strong over the last decade. In both the lumbar and thoracic spine, ultrasound has been shown to optimize technical performance, improve patient outcomes, and potentially reduce harm. Specifically, ultrasound aids in identification of intervertebral levels, estimation of depth to epidural and intrathecal spaces, and localization of important landmarks including the midline and interlaminar space. These characteristics can facilitate both planning and performance of neuraxial blockade by reducing the required number of needle insertions and redirections, minimizing the risk of traumatic needle placements, and improving block effectiveness after epidural placement. This report details the evidence supporting each of these outcomes and also discusses the current understanding of both learning and teaching the skill of neuraxial ultrasonography.

Serratus plane block: a novel ultrasound-guided thoracic wall nerve block

We present a novel ultrasound-guided regional anaesthetic technique that may achieve complete paraesthesia of the hemithorax. This technique may be a viable alternative to current regional anaesthetic techniques such as thoracic paravertebral and central neuraxial blockade, which can be technically more challenging and have a higher potential side-effect profile. We performed the serratus block at two different levels in the midaxillary line on four female volunteers. We recorded the degree of paraesthesia obtained and performed fat-suppression magnetic resonance imaging and three-dimensional reconstructions of the spread of local anaesthetic in the serratus plane. All volunteers reported an effective block that provided long-lasting paraesthesia (750-840 min). There were no side-effects noted in this initial descriptive study. While these are preliminary findings, and must be confirmed in a clinical trial, they highlight the potential for the serratus plane block to provide analgesia following surgery on the thoracic wall. We suggest that this novel approach appears to be safe, effective, and easy to perform, and is associated with a low risk of side-effects.

A northern deanery survey on the consent, prevention and treatment of shivering under neuraxial blockade

Royal Victoria Infirmary, Dept of Anaesthesiology & Intensive Care, Newcastle upon Tyne, United Kingdom

IV Paracetamol as a sole agent for postoperative pain relief in adult cardiac surgical patients after median sternotomy

Various pain control strategies for pain relief of cardiac surgical patients after median sternotomy were tried include central neuraxial blockade or selective nerve blocks, and drugs such as opioids, and non-steroidal anti-inflammatory drugs (NSAIDS). Paracetamol (Perfalgan, Bristol Meyers Squibb) is available in IV formulation and is being used in many centers as an adjunct to analgesia regimen. In our practice, we have found that IV paracetamol stared at regular intervals after shifting the patient to cardiac surgical ICU(CSICU), helps in significantly reducing the analgesic requirement consequently patients become less sedated after cardiac surgery. After ethics committee approval, and informed patient consent, we did a prospective cohort study of 52 adult cardiac surgical receiving IV paracetamol as the primary pain control agent. A standard anesthesia and analgesia technique was used for all the patients. Postoperatively IV fentanyl infusion was continued at 1 mcg/kg/h till extubation. IV paracetamol was started 30 min before extubation given 1 g (over 30 min) IV and continued 6 h till next 72 h or till chest tube removal. Pain control was assessed by visual analogue scale (VAS) and target VAS value of 3 or less than three was considered adequate. VAS was assessed at extubation, at 3, 6, 12, 24, 36 and 48 h after extubation. The regimen was considered successful if only two or less than two doses of IV fentanyl and/or less than 4 doses of oral tramadol were required to supplement IV paracetamol postoperatively. The patient age ranged from 24 to 78 years, 8 of them were female, CABG was performed in 14 patients, AVR in 8 patients, CABG plus MVR in 6 patients, CABG plus AVR in 10 patients, MVR plus RFA in 6 patients, ASD closure in 4 patients and pulmonary valve implantation in 2 patient. We found that paracetamol was successful as the sole analgesic agent in 38 patients (73%), in 10 patients (19.2%) IV paracetamol was primary regimen (with fentanyl/tramadol as adjunct) and in 4 patients (7.6%) patients IV paracetamol regimen was unsuccessful in pain relief. IV Paracatamol may be used as a sole agent for pain relief with successful results after median sternotomy in selected patients in which opioids, NSAIDS or regional blocks are not indicated or produce undesirable side effects. The results need to be reproduced in a larger group of patients and after determining equipotent doses of opiods, case control studies should be done to evaluate the effects of IV paracetamol after median sternotomy.

Preventive Analgesia by Local Anesthetics

The use of local anesthetics to reduce acute postoperative pain has a long history, but recent reports have not been systematically reviewed. In addition, the need to include only those clinical studies that meet minimum standards for randomization and blinding must be adhered to. In this review, we have applied stringent clinical study design standards to identify publications on the use of perioperative local anesthetics. We first examined several types of peripheral nerve blocks, covering a variety of surgical procedures, and second, we examined the effects of intentionally administered IV local anesthetic (lidocaine) for suppression of postoperative pain. Thirdly, we have examined publications in which vascular concentrations of local anesthetics were measured at different times after peripheral nerve block procedures, noting the incidence when those levels reached ones achieved during intentional IV administration. Importantly, the very large number of studies using neuraxial blockade techniques (epidural, spinal) has not been included in this review but will be dealt with separately in a later review. The overall results showed a strongly positive effect of local anesthetics, by either route, for suppressing postoperative pain scores and analgesic (opiate) consumption. In only a few situations were the effects equivocal. Enhanced effectiveness with the addition of adjuvants was not uniformly apparent. The differential benefits between drug delivery before, during, or immediately after a surgical procedure are not obvious, and a general conclusion is that the significant antihyperalgesic effects occur when the local anesthetic is present during the acute postoperative period, and its presence during surgery is not essential for this action.

The use of an online three-dimensional model improves performance in ultrasound scanning of the spine: a randomized trial

The use of ultrasound for neuraxial blockade is a new application of technology that is rapidly becoming accepted as a standard of care. This new skill has shown to improve success, but it is a challenge to teach. To assist with teaching the use of ultrasound in regional anesthesia of the lumbar spine, we have developed an interactive educational model ( http://pie.med.utoronto.ca/vspine or http://www.usra.ca/vspine.php ). In this study, we aimed to determine whether use of this model for a two-week period would improve the performance of novice operators in determining defined landmarks during real-time ultrasound imaging of the lumbar spine. We evaluated the educational benefit of the ultrasound module by randomly assigning 16 postgraduate first-year (PGY1) anesthesia residents to either a control group with password-protected access to only the lumbar anatomy module or to an intervention group with access to the complete module. All residents had access to the module for two weeks following a full-day workshop that is part of the university teaching program which consists of a didactic lecture on ultrasound-facilitated neuraxial anesthesia, mentored teaching on cadaveric spine dissections, and hands-on ultrasound scanning of live models. At the end of the two weeks, the performance of the residents was evaluated using a 12-item task-specific checklist while carrying out a scout scan on a live model. The control group had a median score of 5.5 (25(th) percentile: 4, 75(th) percentile: 18), while the intervention group had a median score of 11.5 (25(th) percentile: 8, 75(th) percentile: 12) in the task-specific checklist, with a significant difference of 6 (confidence interval 1.5 to 10.5) between groups (P = 0.021). Our results show superior performance by the residents who had access to both components of the module, indicating that access to the interactive ultrasound spine module improves knowledge and skills prior to clinical care.