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

Study Overview
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Brief Summary
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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
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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.

Official Title
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a Modified Method That Improved Residency Neuraxial Anesthesia Performance and Reduced Patient Complications

Conditions
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Anesthesia

Intervention / Treatment
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* Procedure: spinal anesthesia
* Procedure: epidural anesthesia
* Procedure: combined spinal-epidural anesthesia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: parturients who were elective for cesarean section Exclusion Criteria: history of allergy to the medications used in this study chronic or acute headaches possible conversion to general anesthesia other contraindications to practice (infection, coagulopathy, abnormal spinal anatomy, unstable vital signs, and refusal to participate in the study)

Ages Eligible for Study
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Minimum Age: 20 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| spinal anesthesia<br>The anesthesia technique were applied with modified approach and conventional approach | Procedure: spinal anesthesia<br>* 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.<br>|
| epidural anesthesia<br>The anesthesia technique were applied with modified approach and conventional approach | Procedure: epidural anesthesia<br>* 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.<br>|
| combined spinal-epidural anesthesia<br>The anesthesia technique were applied with modified approach and conventional approach | Procedure: combined spinal-epidural anesthesia<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| attempts | the number of skin-to-site needle punctures | at least three days | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| complication | all types of complications, including a post dura-puncture headache epidural hematoma, infection, or any unexpected neurologic injury | at least three days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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patient safety, residency training