Modified Paramedian Versus Conventional Technique in the Residency Training: An Observational Study
Condition: Anesthesia
Study type: Observational

Summary: 
      Residency training includes positive and negative aspects. Well-trained doctors must be
      educated, but the process may bring additional risks to patients. Anesthesiologists'
      performance when conducting neuraxial anesthesia is related to their experience. We
      hypothesized that a modified neuraxial anesthesia method would improve both residency
      training and patient safety.
    

Detailed description: 
      Residency training is performed using trial and error. Several studies have shown that the
      training process, practice period, and resident's attitude are important factors for
      determining performance. During the training process, neuraxial anesthesia safety is related
      to the operator's experience. Ultrasound can improve resident performance; however, using
      ultrasound technologies in well-established training programs may not be practical for all
      residencies.

      The paramedian approach bypasses most of the bony structures that may impede the advancement
      of an epidural needle in the midline approach. However, the paramedian approach requires a
      sharpened three-dimensional insight compared with the midline approach. We hypothesized that
      the higher the three-dimensional barrier, the higher the complications and number of puncture
      attempts. A modified paramedian approach may improve residency training and patient safety.
      The aim of this study was to investigate whether the modified method decreased practice
      attempts and patient complications.
    

Intervention name(s): spinal anesthesia; epidural anesthesia; combined spinal-epidural anesthesia
Intervention type(s): Procedure; Procedure; Procedure
Intervention description(s): For conventional spinal anesthesia, injection site was 1 cm lateral and 1 cm caudal to the spinous process, and the needle was directed cephalad and medially to the epidural-subarachnoid space by the operator. For modified method, we reduced the distance from 1cm to 0.5cm in each directions.; For conventional epidural anesthesia, injection site was 1 cm lateral and 1 cm caudal to the spinous process, and the needle was directed cephalad and medially to the epidural-subarachnoid space by the operator. For modified method, we reduced the distance from 1cm to 0.5cm in each directions.; For conventional combined spinal-epidural anesthesia, injection site was 1 cm lateral and 1 cm caudal to the spinous process, and the needle was directed cephalad and medially to the epidural-subarachnoid space by the operator. For modified method, we reduced the distance from 1cm to 0.5cm in each directions.
Intervention MeSH terms: Anesthetics
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        All parturients received regional anesthesia in the decubitus position, and the procedures
        were performed in the L3-4 or L4-5 interspace. For the conventional method, the injection
        site was 1 cm lateral and 1 cm caudal to the spinous process, and the needle was directed
        cephalad and medially to the epidural-subarachnoid space by the operator. For the modified
        method, the injection site was 0.5 cm lateral and 0.5 cm caudal to the spinous process, and
        the process was the same as the conventional method
      
Keywords: patient safety; residency training