Some Common Challenges
To consider the value of peripheral nerve block training using simulators, we must first understand the most common problems, and look back at the history of training.
For years training consisted of didactics, anatomy recognition using cadavers, and practicing on live patients.
A 2006 study with 520 nerve blocks showed 398 errors, with most involving five quality-compromising patterns of behavior: (1) failure to recognize the maldistribution of local anesthesia, (2) failure to recognize an intramuscular location of the needle tip before injection, (3) fatigue, (4) failure to correctly correlate the sidedness of the patient with the sidedness of the ultrasound image, and (5) poor choice of needle-insertion site and angle with respect to the probe preventing accurate needle.¹ This study showed that improvement occurred after practicing at least 66 blocks on patients.
This study demonstrated the need to practice ultrasound probe and needle control and stabilization before moving toward nerves and vessels. This is where simulation becomes most valuable as a pre-block training where participants learn through hands-on practice:
· How to use and stabilize the ultrasound probe
· Ultrasound anatomy recognition
· Needle approach, alignment, depth, and needle tip placement
· Proper injection
The use of an essential trainer offers a systematic approach to pre- and post-testing comparison of the results of the training course.
Anatomical trainers can provide a close simulation of human anatomy. When manufactured correctly, they should include realistic bone, nerve, muscle, fascia, and vessel construction, size, and placement. Simulator ultrasound scans should closely resemble human scans.
Many types of simulators are used for this purpose, including virtual reality and 3D animation. While these are attractive alternatives, they do not provide the crucial hands-on feel of practicing the procedure.
The drawbacks of simulation are reported to be:
· Too costly
· Poor durability
· Requires a lot of set up and post-use care
· Dedicated space for training
· Long learning curve
A Proven Solution
Valkyrie’s MiniSim line of simulators offer not only a proven training protocol, as used in the NYSORA training programs, but they also offer quality, ease of use and storage, a small footprint for practice and storage in even the smallest space, and the largest and most cost-effective selection of peripheral nerve block training simulators.
1. Sites BD, Gallagher JD, Cravero J, Lundberg J, Blike G. The learning curve associated with a simulated ultrasound-guided interventional task by inexperienced anesthesia residents. Reg Anesth Pain Med. 2004 Nov-Dec;29(6):544-8. doi: 10.1016/j.rapm.2004.08.014. PMID: 15635513.