The Exposure of Peripheral Nerve Block in Residency Training Program at Srinagarind Hospital

Abstract

Background and objectives: The demand for peripheral nerve blocks and neuraxial blocks has increased over the last few years. In order to avoid complications of general anesthesia, regional anesthesia provides  adequate perioperative pain management and decreased opioid use which lead to earlier ambulation, shorter hospital stay, reduced cost and increased patient satisfaction. However, residency training program of anesthesiology in Srinagarind Hospital did not keep records regarding the individual resident's cumulative exposure to specific peripheral nerve block techniques. Further, more little is known about individual trainee experience and confidence in performing peripheral nerve block. To improve training and anesthesia practice, such information is necessary. In this study, we assessed residents' exposure cumulative, technique and success rate of peripheral nerve block.

Methods: Retrospective analysis from the medical record of residents over the course of four years who performed peripheral nerve block between April 2005 and April 2011was used. We collected information of the resident training level, number of peripheral nerve blocks performed in each type, and the success rate in performing these techniques.

Results: A total of 26 residents in a 4-year training program, experienced, 149 patients in their individual cumulative exposure to peripheral nerve block techniques per year were evaluated. Only 0.56-1.37% of total patients had performed peripheral nerve block. The number of blocks performed varied widely according to types of block, with brachial plexus block performed more than lower extremity block. Most often at all training levels, supraclavicular brachial plexus block was used must often and sciatic nerve and bier block were performed least. At all training levels, the success rate was high with third-year (72.22%), second-year (56.41%) and first-year (50.75%) residents, respectively. Also ultrasound guidance, paresthesia technique and nerve stimulator were found to improve the success rate of peripheral nerve block, respectively.

Conclusions: The least exposure of peripheral nerve block in the residency training program at Srinagarind Hospital may lead to incompetency in performing the blocks. The training processes needs to be changed to further improve the quality of postgraduate practice.