Regional anesthesia in the combat setting: Are ACGME requirements enough?

Abstract

Introduction: Updated Joint Trauma System Clinical Practice Guidelines (CPG) indicate regional anesthesia and pain management (RAAPM) are important for combat casualty care. However, it is unclear whether militaryanesthesiology residents are receiving adequate RAAPM training to meet the CPGs. The goal of this study was to conduct a preliminary evaluation of resident-completed combat-relevant regional anesthesia procedures. It was hypothesized that most residents would perform an adequate number of each procedure to presume proficiency. Materials andMethods: Resident-performed, combat-relevant regional anesthesia procedure frequency was extracted from a databasemaintained at a military anesthesiology residency program. Data collection was limited to a 1-year period. Univariatestatistics described procedure distributions, frequencies, and proportion of residents achieving pre-defined, empiricallysupported experience criteria for each technique. Analyses examined proportional differences in meeting experiencecriteria by training-year. Results: Residents (N = 41) performed a variety of procedures. Simple procedures, such assaphenous peripheral nerve blocks, were performed at a greater frequency than more complicated procedures such asthoracic epidurals, continuous peripheral nerve blocks, and transverse abdominus plane blocks. The majority of residents met experience criteria for four out of the eight measured combat-relevant blocks. There were no proportionaldifferences in meeting procedural experience criteria across the different training levels. Conclusions: These resultssuggest a possible gap between the needs of the Military Health System during conflict and current residency trainingexperiences. Reasons for this gap, as well as solutions, are explored.