Skip to main content
Erschienen in: Surgical and Radiologic Anatomy 4/2014

01.05.2014 | Teaching Anatomy

Ultrasound-guided regional anesthesia: learning with an optimized cadaver model

verfasst von: Jens Kessler, Bernhard Moriggl, Thomas Grau

Erschienen in: Surgical and Radiologic Anatomy | Ausgabe 4/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

To date, there have been few studies of the simulation of ultrasound-guided regional anesthesia for teaching purposes. The present study aimed to evaluate the visibility of nerves and their adjacent structures, and the feasibility of the use of ultrasound-guided blocks in specially prepared cadavers to develop a new teaching model.

Methods

Nerves of the brachial, lumbar, and sacral plexus were examined, and their visibility evaluated in 12 specially embalmed cadavers. Thereafter a needle was advanced under direct ultrasound guidance to target nerves, and selected blocks were imitated using saline. The model was evaluated with standardized questionnaires in two international workshops with 124 participants.

Results

The selected nerves were successfully identified in all cadavers. The typical ultrasound appearance of nerves and their adjacent structures was very similar to the echotexture of the living, and the spread of injected saline around nerves was comparable to that of local anesthetics used in live patients. 79 % of the participants completed the questionnaire and confirmed the value of this optimized teaching model.

Conclusions

This cadaver model is a promising teaching tool for practicing both the visualization of nerves and the needle manipulation. Moreover, it is possible to simulate the interventional application and the spread of local anesthetics using saline. With the aim of maximizing the effectiveness of teaching, it is hoped that we, and others, may be able to establish the use of this kind of tool as a valuable adjunct to other models of teaching regional anesthesia.
Literatur
1.
Zurück zum Zitat Abu-Zidan FM, Siosteen AK, Wang J, al-Ayoubi F, Lennquist S (2004) Establishment of a teaching animal model for sonographic diagnosis of trauma. J Trauma 56(1):99–104PubMedCrossRef Abu-Zidan FM, Siosteen AK, Wang J, al-Ayoubi F, Lennquist S (2004) Establishment of a teaching animal model for sonographic diagnosis of trauma. J Trauma 56(1):99–104PubMedCrossRef
2.
Zurück zum Zitat Allen J, Meincke K, Ramirez M, Watts R, Marienau MS (2003) A teaching tool in spinal anesthesia. Aana J 71(1):29–36PubMed Allen J, Meincke K, Ramirez M, Watts R, Marienau MS (2003) A teaching tool in spinal anesthesia. Aana J 71(1):29–36PubMed
3.
Zurück zum Zitat Barrington MJ, Wong DM, Slater B, Ivanusic JJ, Ovens M (2012) Ultrasound-guided regional anesthesia: how much practice do novices require before achieving competency in ultrasound needle visualization using a cadaver model. Reg Anesth Pain Med 37(3):334–339. doi:10.1097/AAP.0b013e3182475fba PubMedCrossRef Barrington MJ, Wong DM, Slater B, Ivanusic JJ, Ovens M (2012) Ultrasound-guided regional anesthesia: how much practice do novices require before achieving competency in ultrasound needle visualization using a cadaver model. Reg Anesth Pain Med 37(3):334–339. doi:10.​1097/​AAP.​0b013e3182475fba​ PubMedCrossRef
5.
Zurück zum Zitat Benkhadra M, Faust A, Ladoire S, Trost O, Trouilloud P, Girard C, Anderhuber F, Feigl G (2009) Comparison of fresh and Thiel’s embalmed cadavers according to the suitability for ultrasound-guided regional anesthesia of the cervical region. Surg Radiol Anat 31(7):531–535. doi:10.1007/s00276-009-0477-z PubMedCrossRef Benkhadra M, Faust A, Ladoire S, Trost O, Trouilloud P, Girard C, Anderhuber F, Feigl G (2009) Comparison of fresh and Thiel’s embalmed cadavers according to the suitability for ultrasound-guided regional anesthesia of the cervical region. Surg Radiol Anat 31(7):531–535. doi:10.​1007/​s00276-009-0477-z PubMedCrossRef
6.
Zurück zum Zitat Berthier F, Lepage D, Henry Y, Vuillier F, Christophe JL, Boillot A, Samain E, Tatu L (2010) Anatomical basis for ultrasound-guided regional anesthesia at the junction of the axilla and the upper arm. Surg Radiol Anat 32(3):299–304. doi:10.1007/s00276-009-0539-2 PubMedCrossRef Berthier F, Lepage D, Henry Y, Vuillier F, Christophe JL, Boillot A, Samain E, Tatu L (2010) Anatomical basis for ultrasound-guided regional anesthesia at the junction of the axilla and the upper arm. Surg Radiol Anat 32(3):299–304. doi:10.​1007/​s00276-009-0539-2 PubMedCrossRef
7.
Zurück zum Zitat Bhutani MS, Hoffman BJ, Hawes RH (1998) A swine model for teaching endoscopic ultrasound (EUS) imaging and intervention under EUS guidance. Endoscopy 30(7):605–609PubMedCrossRef Bhutani MS, Hoffman BJ, Hawes RH (1998) A swine model for teaching endoscopic ultrasound (EUS) imaging and intervention under EUS guidance. Endoscopy 30(7):605–609PubMedCrossRef
8.
Zurück zum Zitat Blaivas M, Brannam L, Fernandez E (2003) Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimate model. Acad Emerg Med 10(12):1307–1311PubMedCrossRef Blaivas M, Brannam L, Fernandez E (2003) Short-axis versus long-axis approaches for teaching ultrasound-guided vascular access on a new inanimate model. Acad Emerg Med 10(12):1307–1311PubMedCrossRef
9.
Zurück zum Zitat Blum MG, Powers TW, Sundaresan S (2004) Bronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy. Ann Thorac Surg 78(1):287–291 discussion 287–291PubMedCrossRef Blum MG, Powers TW, Sundaresan S (2004) Bronchoscopy simulator effectively prepares junior residents to competently perform basic clinical bronchoscopy. Ann Thorac Surg 78(1):287–291 discussion 287–291PubMedCrossRef
10.
Zurück zum Zitat Bussen D, Sailer M, Fuchs KH, Thiede A (2004) A teaching model for endorectal ultrasound-guided biopsy and drainage of pararectal tumors. Endoscopy 36(3):217–219PubMedCrossRef Bussen D, Sailer M, Fuchs KH, Thiede A (2004) A teaching model for endorectal ultrasound-guided biopsy and drainage of pararectal tumors. Endoscopy 36(3):217–219PubMedCrossRef
11.
Zurück zum Zitat Casati A, Baciarello M, Cianni SD, Danelli G, De Marco G, Leone S, Rossi M, Fanelli G (2007) Effects of ultrasound guidance on the minimum effective anesthetic volume required to block the femoral nerve. Br J Anaesth 98(6):823–827PubMedCrossRef Casati A, Baciarello M, Cianni SD, Danelli G, De Marco G, Leone S, Rossi M, Fanelli G (2007) Effects of ultrasound guidance on the minimum effective anesthetic volume required to block the femoral nerve. Br J Anaesth 98(6):823–827PubMedCrossRef
12.
Zurück zum Zitat Chan VW, Perlas A, McCartney CJ, Brull R, Xu D, Abbas S (2007) Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth 54(3):176–182PubMedCrossRef Chan VW, Perlas A, McCartney CJ, Brull R, Xu D, Abbas S (2007) Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth 54(3):176–182PubMedCrossRef
13.
Zurück zum Zitat Engum SA, Jeffries P, Fisher L (2003) Intravenous catheter training system: computer-based education versus traditional learning methods. Am J Surg 186(1):67–74PubMedCrossRef Engum SA, Jeffries P, Fisher L (2003) Intravenous catheter training system: computer-based education versus traditional learning methods. Am J Surg 186(1):67–74PubMedCrossRef
14.
15.
Zurück zum Zitat Fritz T, Klein A, Krieglstein C, Mattern R, Kallieris D, Meeder PJ (2000) Teaching model for intraoperative spinal sonography in spinal fractures. An experimental study. Arch Orthop Trauma Surg 120(3–4):183–187PubMedCrossRef Fritz T, Klein A, Krieglstein C, Mattern R, Kallieris D, Meeder PJ (2000) Teaching model for intraoperative spinal sonography in spinal fractures. An experimental study. Arch Orthop Trauma Surg 120(3–4):183–187PubMedCrossRef
16.
Zurück zum Zitat Gasko J, Johnson A, Sherner J, Craig J, Gegel B, Burgert J, Sama S, Franzen T (2012) Effects of using simulation versus CD-ROM in the performance of ultrasound-guided regional anesthesia. Aana J 80(4 Suppl):S56–S59PubMed Gasko J, Johnson A, Sherner J, Craig J, Gegel B, Burgert J, Sama S, Franzen T (2012) Effects of using simulation versus CD-ROM in the performance of ultrasound-guided regional anesthesia. Aana J 80(4 Suppl):S56–S59PubMed
17.
Zurück zum Zitat Harvey JA, Moran RE, Hamer MM, DeAngelis GA, Omary RA (1997) Evaluation of a turkey-breast phantom for teaching freehand. US-guided core-needle breast biopsy. Acad Radiol 4(8):565–569PubMedCrossRef Harvey JA, Moran RE, Hamer MM, DeAngelis GA, Omary RA (1997) Evaluation of a turkey-breast phantom for teaching freehand. US-guided core-needle breast biopsy. Acad Radiol 4(8):565–569PubMedCrossRef
18.
Zurück zum Zitat Heer IM, Middendorf K, Muller-Egloff S, Dugas M, Strauss A (2004) Ultrasound training: the virtual patient. Ultrasound Obstet Gynecol 24(4):440–444PubMedCrossRef Heer IM, Middendorf K, Muller-Egloff S, Dugas M, Strauss A (2004) Ultrasound training: the virtual patient. Ultrasound Obstet Gynecol 24(4):440–444PubMedCrossRef
19.
Zurück zum Zitat Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, Marhofer P (2008) Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 33(3):253–258PubMedCrossRef Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, Marhofer P (2008) Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 33(3):253–258PubMedCrossRef
20.
Zurück zum Zitat Katz R, Hoznek A, Antiphon P, Van Velthoven R, Delmas V, Abbou CC (2003) Cadaveric versus porcine models in urological laparoscopic training. Urol Int 71(3):310–315PubMedCrossRef Katz R, Hoznek A, Antiphon P, Van Velthoven R, Delmas V, Abbou CC (2003) Cadaveric versus porcine models in urological laparoscopic training. Urol Int 71(3):310–315PubMedCrossRef
21.
Zurück zum Zitat Kopacz DJ (1995) A simple model to teach three basic regional anesthesia principles. Anesth Analg 81(1):167–169PubMed Kopacz DJ (1995) A simple model to teach three basic regional anesthesia principles. Anesth Analg 81(1):167–169PubMed
22.
Zurück zum Zitat Lee W, Ault H, Kirk JS, Comstock CH (1995) Interactive multimedia for prenatal ultrasound training. Obstet Gynecol 85(1):135–140PubMedCrossRef Lee W, Ault H, Kirk JS, Comstock CH (1995) Interactive multimedia for prenatal ultrasound training. Obstet Gynecol 85(1):135–140PubMedCrossRef
23.
Zurück zum Zitat Lim MW, Burt G, Rutter SV (2005) Use of three-dimensional animation for regional anesthesia teaching: application to interscalene brachial plexus blockade. Br J Anaesth 94(3):372–377PubMedCrossRef Lim MW, Burt G, Rutter SV (2005) Use of three-dimensional animation for regional anesthesia teaching: application to interscalene brachial plexus blockade. Br J Anaesth 94(3):372–377PubMedCrossRef
24.
Zurück zum Zitat Marhofer P, Schrogendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N (1997) Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg 85(4):854–857PubMed Marhofer P, Schrogendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N (1997) Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg 85(4):854–857PubMed
25.
Zurück zum Zitat Marhofer P, Sitzwohl C, Greher M, Kapral S (2004) Ultrasound guidance for infraclavicular brachial plexus anesthesia in children. Anesthesia 59(7):642–646CrossRef Marhofer P, Sitzwohl C, Greher M, Kapral S (2004) Ultrasound guidance for infraclavicular brachial plexus anesthesia in children. Anesthesia 59(7):642–646CrossRef
26.
Zurück zum Zitat Michalek P, Donaldson W, McAleavey F, Johnston P, Kiska R (2013) Ultrasound imaging of the infraorbital foramen and simulation of the ultrasound-guided infraorbital nerve block using a skull model. Surg Radiol Anat 35(4):319–322. doi:10.1007/s00276-012-1039-3 PubMedCrossRef Michalek P, Donaldson W, McAleavey F, Johnston P, Kiska R (2013) Ultrasound imaging of the infraorbital foramen and simulation of the ultrasound-guided infraorbital nerve block using a skull model. Surg Radiol Anat 35(4):319–322. doi:10.​1007/​s00276-012-1039-3 PubMedCrossRef
28.
Zurück zum Zitat Obst T, Burgkart R, Ruckhaberle E, Riener R (2004) The delivery simulator: a new application of medical VR. Stud Health Technol Inform 98:281–287PubMed Obst T, Burgkart R, Ruckhaberle E, Riener R (2004) The delivery simulator: a new application of medical VR. Stud Health Technol Inform 98:281–287PubMed
29.
Zurück zum Zitat Restrepo JI, Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM (2001) Laparoscopic ultrasonography: a training model. Dis Colon Rectum 44(5):632–637PubMedCrossRef Restrepo JI, Stocchi L, Nelson H, Young-Fadok TM, Larson DR, Ilstrup DM (2001) Laparoscopic ultrasonography: a training model. Dis Colon Rectum 44(5):632–637PubMedCrossRef
30.
Zurück zum Zitat Rowland EB, Kleinert JM (1994) Endoscopic carpal-tunnel release in cadavera. An investigation of the results of twelve surgeons with this training model. J Bone Joint Surg Am 76(2):266–268PubMed Rowland EB, Kleinert JM (1994) Endoscopic carpal-tunnel release in cadavera. An investigation of the results of twelve surgeons with this training model. J Bone Joint Surg Am 76(2):266–268PubMed
31.
Zurück zum Zitat Salen P, O’Connor R, Passarello B, Pancu D, Melanson S, Arcona S, Heller M (2001) Fast education: a comparison of teaching models for trauma sonography. J Emerg Med 20(4):421–425PubMedCrossRef Salen P, O’Connor R, Passarello B, Pancu D, Melanson S, Arcona S, Heller M (2001) Fast education: a comparison of teaching models for trauma sonography. J Emerg Med 20(4):421–425PubMedCrossRef
32.
Zurück zum Zitat Schaefer JJ 3rd (2004) Simulators and difficult airway management skills. Paediatr Anaesth 14(1):28–37PubMedCrossRef Schaefer JJ 3rd (2004) Simulators and difficult airway management skills. Paediatr Anaesth 14(1):28–37PubMedCrossRef
33.
Zurück zum Zitat Schwarz G, Feigl G, Kleinert R, Dorn C, Litscher G, Sandner-Kiesling A, Bock N (2002) Pneumatic pulse simulation for teaching peripheral plexus blocks in cadavers. Anesth Analg 95(6):1822–1823PubMedCrossRef Schwarz G, Feigl G, Kleinert R, Dorn C, Litscher G, Sandner-Kiesling A, Bock N (2002) Pneumatic pulse simulation for teaching peripheral plexus blocks in cadavers. Anesth Analg 95(6):1822–1823PubMedCrossRef
34.
Zurück zum Zitat Silvestri E, Martinoli C, Derchi LE, Bertolotto M, Chiaramondia M, Rosenberg I (1995) Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology 197(1):291–296PubMed Silvestri E, Martinoli C, Derchi LE, Bertolotto M, Chiaramondia M, Rosenberg I (1995) Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology 197(1):291–296PubMed
35.
Zurück zum Zitat Sites BD, Gallagher JD, Cravero J, Lundberg J, Blike G (2004) The learning curve associated with a simulated ultrasound-guided interventional task by inexperienced anesthesia residents. Reg Anesth Pain Med 29(6):544–548PubMedCrossRef Sites BD, Gallagher JD, Cravero J, Lundberg J, Blike G (2004) The learning curve associated with a simulated ultrasound-guided interventional task by inexperienced anesthesia residents. Reg Anesth Pain Med 29(6):544–548PubMedCrossRef
36.
Zurück zum Zitat Smith JF Jr, Bergmann M, Gildersleeve R, Allen R (1998) A simple model for learning stereotactic skills in ultrasound-guided amniocentesis. Obstet Gynecol 92(2):303–305PubMedCrossRef Smith JF Jr, Bergmann M, Gildersleeve R, Allen R (1998) A simple model for learning stereotactic skills in ultrasound-guided amniocentesis. Obstet Gynecol 92(2):303–305PubMedCrossRef
37.
Zurück zum Zitat Supe A, Dalvi A, Prabhu R, Kantharia C, Bhuiyan P (2005) Cadaver as a model for laparoscopic training. Indian J Gastroenterol 24(3):111–113PubMed Supe A, Dalvi A, Prabhu R, Kantharia C, Bhuiyan P (2005) Cadaver as a model for laparoscopic training. Indian J Gastroenterol 24(3):111–113PubMed
38.
Zurück zum Zitat Tsui BC, Dillane D, Pillay J, Ramji AK, Walji AH (2007) Cadaveric ultrasound imaging for training in ultrasound-guided peripheral nerve blocks: lower extremity. Can J Anaesth 54(6):475–480PubMedCrossRef Tsui BC, Dillane D, Pillay J, Ramji AK, Walji AH (2007) Cadaveric ultrasound imaging for training in ultrasound-guided peripheral nerve blocks: lower extremity. Can J Anaesth 54(6):475–480PubMedCrossRef
39.
Zurück zum Zitat Tsui BC, Dillane D, Walji AH (2007) Cadaveric ultrasound imaging for training in ultrasound-guided peripheral nerve blocks: upper extremity. Can J Anaesth 54(5):392–396PubMedCrossRef Tsui BC, Dillane D, Walji AH (2007) Cadaveric ultrasound imaging for training in ultrasound-guided peripheral nerve blocks: upper extremity. Can J Anaesth 54(5):392–396PubMedCrossRef
40.
Zurück zum Zitat Ville Y, Cooper M, Revel A, Frydman R, Nicolaides KH (1995) Development of a training model for ultrasound-guided invasive procedures in fetal medicine. Ultrasound Obstet Gynecol 5(3):180–183PubMedCrossRef Ville Y, Cooper M, Revel A, Frydman R, Nicolaides KH (1995) Development of a training model for ultrasound-guided invasive procedures in fetal medicine. Ultrasound Obstet Gynecol 5(3):180–183PubMedCrossRef
41.
Zurück zum Zitat Xu D, Abbas S, Chan VW (2005) Ultrasound phantom for hands-on practice. Reg Anesth Pain Med 30(6):593–594PubMedCrossRef Xu D, Abbas S, Chan VW (2005) Ultrasound phantom for hands-on practice. Reg Anesth Pain Med 30(6):593–594PubMedCrossRef
42.
Zurück zum Zitat Zink W, Bernhard M, Keul W, Martin E, Volkl A, Gries A (2004) Invasive techniques in emergency medicine. I. Practice-oriented training concept to ensure adequately qualified emergency physicians. Anesthesist 53(11):1086–1092CrossRef Zink W, Bernhard M, Keul W, Martin E, Volkl A, Gries A (2004) Invasive techniques in emergency medicine. I. Practice-oriented training concept to ensure adequately qualified emergency physicians. Anesthesist 53(11):1086–1092CrossRef
Metadaten
Titel
Ultrasound-guided regional anesthesia: learning with an optimized cadaver model
verfasst von
Jens Kessler
Bernhard Moriggl
Thomas Grau
Publikationsdatum
01.05.2014
Verlag
Springer Paris
Erschienen in
Surgical and Radiologic Anatomy / Ausgabe 4/2014
Print ISSN: 0930-1038
Elektronische ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-013-1188-z

Weitere Artikel der Ausgabe 4/2014

Surgical and Radiologic Anatomy 4/2014 Zur Ausgabe

Update Radiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.