Background and Objectives. Wide variability exists in the amount of regional anesthesia practice to which residents are exposed during training. The number of attempts at various blocks before a trainee becomes proficient at performing these regional anesthetic techniques is not known. This study addresses the question: What is the minimum number of blocks a resident must perform to reach consistency during training in these techniques? Methods. Every regional anesthetic technique attempted by all beginning CA-1 anesthesiology residents (n = 7) during their first 6 months of training (July 1993 to December 1993) were recorded on a daily basis. Nonregional anesthetic techniques attempted were recorded for comparison. The objective measures used to define the degree of success were obtaining cerebro-spinal fluid during attempted spinal anesthesia, subsequent anesthetic block during epidural placement, and detection of end-tidal carbon dioxide for endotracheal intubation. Results. An average of 77 ± 9 epidural anesthetics, 44 ± 6 spinal anesthetics, and 86 ± 13 endotracheal intubations were attempted during the 6 months of training. The learning curves for each technique are of similar shape. Residents show significant (P < .05) improvement over baseline after 20 spinal and 25 epidural anesthetics, but a 90% success rate is not reached and maintained until 45 spinal and 60 epidural anesthetics are performed. Conclusions. Approximately 20-25 procedures each are necessary before improvement in the techniques of spinal and epidural anesthesia is demonstrated by residents in training. If a 90% success rate is desired, 45 and 60 attempts at spinal and epidural anesthesia, respectively, may be necessary.
CITATION STYLE
Kopacz, D. J., Neal, J. M., & Pollock, J. E. (1996). The regional anesthesia learning curve: What is the minimum number of epidural and spinal blocks to reach consistency? Regional Anesthesia, 21(3), 182–190.
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