Single and Double Operator Techniques in Ultrasound-guided Peripheral Nerve Block Learning Curve

Study Overview
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Brief Summary
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Aim of this study is to compare learning curves of single(1- Jedi grip: Pappin and Christie/ 2- Bedforth/ 3- on lock: Gupta and Berrill) and double operator ultrasound-guided peripheric nerve block techniques on a home-made gelatin-based phantom model.

Detailed Description
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Ultrasound-guided peripheral blocks are conventionaly performed by double operators. One operator controls both the ultrasound probe and peripheric block needle. Another assistant operator aspirate or injects local anesthetic. In this technique operator do not sense resistance in the syringe. Also this technique requires a well-done communication and coordination between operators. In order to eliminate disadvantages of this technique several single-operator grip techniques of the needle and syringe have been described(1- Jedi grip: Pappin and Christie/ 2- Bedforth/ 3- on lock: Gupta and Berrill). Single operator techniques allow the provider to perform independently. Aim of this study is to compare learning curves of single and double operator ultrasound-guided peripheric nerve block techniques on a home-made gelatin-based phantom model.

Official Title
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Comparison of Single and Double Operator Techniques in Ultrasound-guided Peripheral Nerve Block Learning Curve for Anesthesia Residency Training on a Gelatin-based Phantom Model: a Prospective Randomized Controlled Study

Conditions
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Single-handed Ultrasound-guided Regional Anaesthesia Grip, Single-operator Ultrasound-guided Peripheric Nerve Block, Anesthesiology Training, Jedi Grip

Intervention / Treatment
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* Other: reaching targeted area on the phantom model


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: - To be a junior resident of anesthesiology(< 2 years ) Exclusion Criteria: Refusal of resident

Ages Eligible for Study
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Minimum Age: 24 Years
Maximum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Other
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Double Operator Ultrasound-Guided Regional Anesthesia<br>resident control block needle and ultrasound probe and asistant operator inject the solution. resident reach the target area created in the phantom model using a block needle with ultrasound guidance | Other: reaching targeted area on the phantom model<br>* resident reach the targeted area on the phantom model using ultrasoun guidance and independently or with asistance inject the solution<br>|
| Active Comparator: Jedi Grip<br>resident control block needle, ultrasound probe and syringe independently with jedi grip; reach the target area created in the phantom model using a block needle with ultrasound guidance; inject and aspirate the solution. | Other: reaching targeted area on the phantom model<br>* resident reach the targeted area on the phantom model using ultrasoun guidance and independently or with asistance inject the solution<br>|
| Active Comparator: On-lock grip<br>resident control block needle, ultrasound probe and syringe independently with on-lock grip; reach the target area created in the phantom model using a block needle with ultrasound guidance; inject the solution. | Other: reaching targeted area on the phantom model<br>* resident reach the targeted area on the phantom model using ultrasoun guidance and independently or with asistance inject the solution<br>|
| Active Comparator: Bedforth alternative grip<br>resident control block needle, ultrasound probe and syringe independently with bedforth's alternative grip; reach the target area created in the phantom model using a block needle with ultrasound guidance; inject the solution. | Other: reaching targeted area on the phantom model<br>* resident reach the targeted area on the phantom model using ultrasoun guidance and independently or with asistance inject the solution<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to correct grip1 | Time(sec) from start command to correct grip of the probe, needle and syringe for each technique | during implementation of procedure on phantom model(first session) | 
| image quality1 | provided image quality by resident for each technique which is assessed by investigator by four point Liker Scale( 1- much worse 2- worse 3- better 4- much better) | during implementation of procedure on phantom model(first session) | 
| number of attempts1 | number of attempts until correct needling to target area | during implementation of procedure on phantom model(first session) | 
| needling time 1 | time to reach target area with block needle | during implementation of procedure on phantom model(first session) | 
| success of injection1 | successful if injected water flows from hose of model/ unsuccessful if solution do not flow | during implementation of procedure on phantom model(first session) | 
| Time to correct grip2 | Time(sec) from start command to correct grip of the probe, needle and syringe for each technique | during implementation of procedure on phantom model(second session) | 
| Time to correct grip3 | Time(sec) from start command to correct grip of the probe, needle and syringe for each technique | during implementation of procedure on phantom model(third session) | 
| image quality2 | provided image quality by resident for each technique which is assessed by investigator by four point Liker Scale( 1- much worse 2- worse 3- better 4- much better) | during implementation of procedure on phantom model(second session) | 
| image quality3 | provided image quality by resident for each technique which is assessed by investigator by four point Liker Scale( 1- much worse 2- worse 3- better 4- much better) | during implementation of procedure on phantom model(third session) | 
| number of attempts2 | number of attempts until correct needling to target area | during implementation of procedure on phantom model(second session) | 
| number of attempts3 | number of attempts until correct needling to target area | during implementation of procedure on phantom model(third session) | 
| needling time 2 | time to reach target area with block needle | during implementation of procedure on phantom model(second session) | 
| needling time 3 | time to reach target area with block needle | during implementation of procedure on phantom model(third session) | 
| success of injection2 | successful if injected water flows from hose of model/ unsuccessful if solution do not flow | during implementation of procedure on phantom model(second session) | 
| success of injection3 | successful if injected water flows from hose of model/ unsuccessful if solution do not flow | during implementation of procedure on phantom model(third session) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| NASA-TLX (NASA Task Load Index) | Resident assessment of each techniques for Mental Demand ,Physical Demand, Temporal Demand, Performance, Effort and Frustration | during implementation of procedure on phantom model(third session) | 
| Assesment of education | Residents assesment of pre-procedural education with a questtionarie. Education was sufficient enough to safely perform peripheral block: I absolutely agree I approve I am indecisive I do not approve Absolutely Disagree | during education of techniques | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Jedi Grip, single-operator ultrasound-guided regional anaesthesia grip, Single-handed ultrasound-guided regional anaesthesia, 'On lock' grip, Anesthesiology training