Top

Surgical and Radiologic Anatomy

Published in:

01-05-2014 | Teaching Anatomy

Ultrasound-guided regional anesthesia: learning with an optimized cadaver model

Authors: Jens Kessler, Bernhard Moriggl, Thomas Grau

Published in: Surgical and Radiologic Anatomy | Issue 4/2014

Abstract

Purpose

To date, there have been few studies of the simulation of ultrasound-guided regional anesthesia for teaching purposes. The present study aimed to evaluate the visibility of nerves and their adjacent structures, and the feasibility of the use of ultrasound-guided blocks in specially prepared cadavers to develop a new teaching model.

Methods

Nerves of the brachial, lumbar, and sacral plexus were examined, and their visibility evaluated in 12 specially embalmed cadavers. Thereafter a needle was advanced under direct ultrasound guidance to target nerves, and selected blocks were imitated using saline. The model was evaluated with standardized questionnaires in two international workshops with 124 participants.

Results

The selected nerves were successfully identified in all cadavers. The typical ultrasound appearance of nerves and their adjacent structures was very similar to the echotexture of the living, and the spread of injected saline around nerves was comparable to that of local anesthetics used in live patients. 79 % of the participants completed the questionnaire and confirmed the value of this optimized teaching model.

Conclusions

This cadaver model is a promising teaching tool for practicing both the visualization of nerves and the needle manipulation. Moreover, it is possible to simulate the interventional application and the spread of local anesthetics using saline. With the aim of maximizing the effectiveness of teaching, it is hoped that we, and others, may be able to establish the use of this kind of tool as a valuable adjunct to other models of teaching regional anesthesia.

Abu-Zidan FM, Siosteen AK, Wang J, al-Ayoubi F, Lennquist S (2004) Establishment of a teaching animal model for sonographic diagnosis of trauma. J Trauma 56(1):99–104PubMedCrossRef

Allen J, Meincke K, Ramirez M, Watts R, Marienau MS (2003) A teaching tool in spinal anesthesia. Aana J 71(1):29–36PubMed

Barrington MJ, Wong DM, Slater B, Ivanusic JJ, Ovens M (2012) Ultrasound-guided regional anesthesia: how much practice do novices require before achieving competency in ultrasound needle visualization using a cadaver model. Reg Anesth Pain Med 37(3):334–339. doi:10.1097/AAP.0b013e3182475fba PubMedCrossRef

Batson OV (1924) Cadavera with flexible joints. Science 60(1554):336–337PubMedCrossRef

Benkhadra M, Faust A, Ladoire S, Trost O, Trouilloud P, Girard C, Anderhuber F, Feigl G (2009) Comparison of fresh and Thiel’s embalmed cadavers according to the suitability for ultrasound-guided regional anesthesia of the cervical region. Surg Radiol Anat 31(7):531–535. doi:10.1007/s00276-009-0477-z PubMedCrossRef

Berthier F, Lepage D, Henry Y, Vuillier F, Christophe JL, Boillot A, Samain E, Tatu L (2010) Anatomical basis for ultrasound-guided regional anesthesia at the junction of the axilla and the upper arm. Surg Radiol Anat 32(3):299–304. doi:10.1007/s00276-009-0539-2 PubMedCrossRef

Bhutani MS, Hoffman BJ, Hawes RH (1998) A swine model for teaching endoscopic ultrasound (EUS) imaging and intervention under EUS guidance. Endoscopy 30(7):605–609PubMedCrossRef

Blaivas M, Brannam L, Fernandez E (2003) Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimate model. Acad Emerg Med 10(12):1307–1311PubMedCrossRef

Blum MG, Powers TW, Sundaresan S (2004) Bronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy. Ann Thorac Surg 78(1):287–291 discussion 287–291PubMedCrossRef

10.

Bussen D, Sailer M, Fuchs KH, Thiede A (2004) A teaching model for endorectal ultrasound-guided biopsy and drainage of pararectal tumors. Endoscopy 36(3):217–219PubMedCrossRef

11.

Casati A, Baciarello M, Cianni SD, Danelli G, De Marco G, Leone S, Rossi M, Fanelli G (2007) Effects of ultrasound guidance on the minimum effective anesthetic volume required to block the femoral nerve. Br J Anaesth 98(6):823–827PubMedCrossRef

12.

Chan VW, Perlas A, McCartney CJ, Brull R, Xu D, Abbas S (2007) Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth 54(3):176–182PubMedCrossRef

13.

Engum SA, Jeffries P, Fisher L (2003) Intravenous catheter training system: computer-based education versus traditional learning methods. Am J Surg 186(1):67–74PubMedCrossRef

14.

Feigl G, Anderhuber F, Schwarz G, Dorn C, Fasel J, Likar R (2007) Training methods for regional anesthesia. Evaluation and comparison. Anesthesist 56(5):437–443. doi:10.1007/s00101-007-1149-1 CrossRef

15.

Fritz T, Klein A, Krieglstein C, Mattern R, Kallieris D, Meeder PJ (2000) Teaching model for intraoperative spinal sonography in spinal fractures. An experimental study. Arch Orthop Trauma Surg 120(3–4):183–187PubMedCrossRef

16.

Gasko J, Johnson A, Sherner J, Craig J, Gegel B, Burgert J, Sama S, Franzen T (2012) Effects of using simulation versus CD-ROM in the performance of ultrasound-guided regional anesthesia. Aana J 80(4 Suppl):S56–S59PubMed

17.

Harvey JA, Moran RE, Hamer MM, DeAngelis GA, Omary RA (1997) Evaluation of a turkey-breast phantom for teaching freehand. US-guided core-needle breast biopsy. Acad Radiol 4(8):565–569PubMedCrossRef

18.

Heer IM, Middendorf K, Muller-Egloff S, Dugas M, Strauss A (2004) Ultrasound training: the virtual patient. Ultrasound Obstet Gynecol 24(4):440–444PubMedCrossRef

19.

Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, Marhofer P (2008) Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 33(3):253–258PubMedCrossRef

20.

Katz R, Hoznek A, Antiphon P, Van Velthoven R, Delmas V, Abbou CC (2003) Cadaveric versus porcine models in urological laparoscopic training. Urol Int 71(3):310–315PubMedCrossRef

21.

Kopacz DJ (1995) A simple model to teach three basic regional anesthesia principles. Anesth Analg 81(1):167–169PubMed

22.

Lee W, Ault H, Kirk JS, Comstock CH (1995) Interactive multimedia for prenatal ultrasound training. Obstet Gynecol 85(1):135–140PubMedCrossRef

23.

Lim MW, Burt G, Rutter SV (2005) Use of three-dimensional animation for regional anesthesia teaching: application to interscalene brachial plexus blockade. Br J Anaesth 94(3):372–377PubMedCrossRef

24.

Marhofer P, Schrogendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N (1997) Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg 85(4):854–857PubMed

25.

Marhofer P, Sitzwohl C, Greher M, Kapral S (2004) Ultrasound guidance for infraclavicular brachial plexus anesthesia in children. Anesthesia 59(7):642–646CrossRef

26.

Michalek P, Donaldson W, McAleavey F, Johnston P, Kiska R (2013) Ultrasound imaging of the infraorbital foramen and simulation of the ultrasound-guided infraorbital nerve block using a skull model. Surg Radiol Anat 35(4):319–322. doi:10.1007/s00276-012-1039-3 PubMedCrossRef

27.

Muhly WT, Orebaugh SL (2011) Ultrasound evaluation of the anatomy of the vessels in relation to the femoral nerve at the femoral crease. Surg Radiol Anat 33(6):491–494. doi:10.1007/s00276-010-0755-9 PubMedCrossRef

28.

Obst T, Burgkart R, Ruckhaberle E, Riener R (2004) The delivery simulator: a new application of medical VR. Stud Health Technol Inform 98:281–287PubMed

29.

Restrepo JI, Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM (2001) Laparoscopic ultrasonography: a training model. Dis Colon Rectum 44(5):632–637PubMedCrossRef

30.

Rowland EB, Kleinert JM (1994) Endoscopic carpal-tunnel release in cadavera. An investigation of the results of twelve surgeons with this training model. J Bone Joint Surg Am 76(2):266–268PubMed

31.

Salen P, O’Connor R, Passarello B, Pancu D, Melanson S, Arcona S, Heller M (2001) Fast education: a comparison of teaching models for trauma sonography. J Emerg Med 20(4):421–425PubMedCrossRef

32.

Schaefer JJ 3rd (2004) Simulators and difficult airway management skills. Paediatr Anaesth 14(1):28–37PubMedCrossRef

33.

Schwarz G, Feigl G, Kleinert R, Dorn C, Litscher G, Sandner-Kiesling A, Bock N (2002) Pneumatic pulse simulation for teaching peripheral plexus blocks in cadavers. Anesth Analg 95(6):1822–1823PubMedCrossRef

34.

Silvestri E, Martinoli C, Derchi LE, Bertolotto M, Chiaramondia M, Rosenberg I (1995) Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology 197(1):291–296PubMed

35.

Sites BD, Gallagher JD, Cravero J, Lundberg J, Blike G (2004) The learning curve associated with a simulated ultrasound-guided interventional task by inexperienced anesthesia residents. Reg Anesth Pain Med 29(6):544–548PubMedCrossRef

36.

Smith JF Jr, Bergmann M, Gildersleeve R, Allen R (1998) A simple model for learning stereotactic skills in ultrasound-guided amniocentesis. Obstet Gynecol 92(2):303–305PubMedCrossRef

37.

Supe A, Dalvi A, Prabhu R, Kantharia C, Bhuiyan P (2005) Cadaver as a model for laparoscopic training. Indian J Gastroenterol 24(3):111–113PubMed

38.

Tsui BC, Dillane D, Pillay J, Ramji AK, Walji AH (2007) Cadaveric ultrasound imaging for training in ultrasound-guided peripheral nerve blocks: lower extremity. Can J Anaesth 54(6):475–480PubMedCrossRef

39.

Tsui BC, Dillane D, Walji AH (2007) Cadaveric ultrasound imaging for training in ultrasound-guided peripheral nerve blocks: upper extremity. Can J Anaesth 54(5):392–396PubMedCrossRef

40.

Ville Y, Cooper M, Revel A, Frydman R, Nicolaides KH (1995) Development of a training model for ultrasound-guided invasive procedures in fetal medicine. Ultrasound Obstet Gynecol 5(3):180–183PubMedCrossRef

41.

Xu D, Abbas S, Chan VW (2005) Ultrasound phantom for hands-on practice. Reg Anesth Pain Med 30(6):593–594PubMedCrossRef

42.

Zink W, Bernhard M, Keul W, Martin E, Volkl A, Gries A (2004) Invasive techniques in emergency medicine. I. Practice-oriented training concept to ensure adequately qualified emergency physicians. Anesthesist 53(11):1086–1092CrossRef

Title: Ultrasound-guided regional anesthesia: learning with an optimized cadaver model
Authors: Jens Kessler
Bernhard Moriggl
Thomas Grau
Publication date: 01-05-2014
Publisher: Springer Paris
Published in: Surgical and Radiologic Anatomy / Issue 4/2014
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-013-1188-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Ultrasound-guided regional anesthesia: learning with an optimized cadaver model

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2014

Size and location of thyroid gland in the fetal period

Arthroscopy of the sternoclavicular joint: an anatomic evaluation of structures at risk

A1 segment hypoplasia accompanied by AcomA aneurysms assessed with magnetic resonance angiography

Circumportal pancreas: a clinicoradiological and embryological review

Functional lengths of the lower limb arterial tree measured by CT angiography centreline analysis: implications for catheter lengths in peripheral angioplasty

High and dehiscent jugular bulb: clear and present danger during middle ear surgery