Simulation-Based Medical Education and Training Enhance Anesthesia Residents' Proficiency in Erector Spinae Plane Block

Vito Torrano; Francesco Zadek; Dario Bugada; Gianluca Cappelleri; Gianluca Russo; Giulia Tinti; Antonio Giorgi; Thomas Langer; Roberto Fumagalli

doi:10.3389/fmed.2022.870372

Simulation-Based Medical Education and Training Enhance Anesthesia Residents' Proficiency in Erector Spinae Plane Block

Front Med (Lausanne). 2022 Apr 8:9:870372. doi: 10.3389/fmed.2022.870372. eCollection 2022.

Authors

Vito Torrano^{1

2}, Francesco Zadek¹, Dario Bugada³, Gianluca Cappelleri⁴, Gianluca Russo⁵, Giulia Tinti¹, Antonio Giorgi¹, Thomas Langer^{1

2}, Roberto Fumagalli^{1

2}

Affiliations

¹ Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy.
² Department of Anesthesia and Intensive Care Medicine, Niguarda Ca' Granda, Milan, Italy.
³ Department of Emergency and Critical Care Medicine, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy.
⁴ Anesthesia and Intensive Care Unit, Policlinico di Monza, Monza, Italy.
⁵ Department of Emergency and Urgency, Azienda Socio Sanitaria Territoriale Lodi, Lodi, Italy.

Abstract

Background: Advances in regional anesthesia and pain management led to the advent of ultrasound-guided fascial plane blocks, which represent a new and promising route for the administration of local anesthetics. Both practical and theoretical knowledge of locoregional anesthesia are therefore becoming fundamental, requiring specific training programs for residents. Simulation-based medical education and training (SBET) has been recently applied to ultrasound-guided regional anesthesia (UGRA) with remarkable results. With this in mind, the anesthesia and intensive care residency program of the University of Milano-Bicocca organized a 4-h regional anesthesia training workshop with the BlockSim^® (Accurate Srl, Cesena) simulator. Our study aimed to measure the residents' improvement in terms of reduction in time required to achieve an erector spinae plane (ESP) block.

Methods: Fifty-two first-year anesthesia residents were exposed to a 4-h training workshop focused on peripheral blocks. The course included an introductory theoretical session held by a locoregional anesthetist expert, a practical training on human models and mannequins using Onvision^® (B. Braun, Milano) technologies, and two test performances on the BlockSim simulator. Residents were asked to perform two ESP blocks on the BlockSim: the first without previous practice on the simulator, the second at the end of the course. Trainees were also also asked to complete a self-assessment questionnaire.

Results: The time needed to achieve the block during the second attempt was significantly shorter (131 [83, 198] vs. 68 [27, 91] s, p < 0.001). We also observed a reduction in the number of needle insertions from 3 [2, 7] to 2 [1, 4] (p = 0.002), and an improvement aiming correctly at the ESP from 30 (58%) to 46 (88%) (p < 0.001). Forty-nine (94%) of the residents reported to have improved their regional anesthesia knowledge, 38 (73%) perceived an improvement in their technical skills and 46 (88%) of the trainees declared to be "satisfied/very satisfied" with the course.

Conclusions: A 4-h hands-on course based on SBET may enhance first-year residents' UGRA ability, decrease the number of punctures and time needed to perform the ESP block, and improve the correct aim of the fascia.

Keywords: erector spinae plane (ESP) block; high fidelity simulation; improved proficiency; medical education; resident training; ultrasound-guided regional anesthesia.