Ultrasound Training for Emergency Medicine Education

Overseen By Abha Singh

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Duke University

Disqualifiers: ED nursing, ED technicians, APPs

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to enhance emergency medicine training by testing a new ultrasound-guided nerve block technique. It focuses on teaching doctors to use ultrasound to guide a nerve block, aiding in pain management during emergencies. The researchers seek to determine if their training model, the Ultrasound-guided Nerve Block Training Model and Evaluation Method, is practical and useful for doctors. Emergency medicine attending and resident physicians are ideal candidates for this trial. As an unphased trial, it offers participants a unique opportunity to contribute to advancing medical education and improving emergency care practices.

Will I have to stop taking my current medications?

The trial protocol does not specify whether participants must stop taking their current medications.

What prior data suggests that this ultrasound-guided nerve block training model is safe for emergency medicine education?

Research has shown that using ultrasound to guide nerve blocks is generally safe and well-tolerated. Studies have found that ultrasound guidance makes these procedures more effective and safer than methods like using physical landmarks or nerve stimulators, reducing the risk of complications.

For training, simulation models are commonly used. One small study found that training emergency medicine residents with a simulated model effectively taught nerve blocks, with no safety issues reported during the training.

In summary, using ultrasound for nerve blocks is considered safe, and training with simulation models is also safe for learners. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores innovative ways to enhance emergency medicine education using ultrasound-guided nerve block training. Unlike traditional training methods that may rely heavily on lectures or textbooks, this approach provides hands-on, practical experience with advanced technology. By focusing on real-time ultrasound guidance, the method aims to improve accuracy and confidence among emergency medicine physicians and residents, potentially leading to better patient outcomes and more efficient medical procedures.

What evidence suggests that this training model is effective for emergency medicine education?

Research has shown that using ultrasound to guide serratus anterior plane blocks (SAPBs) effectively manages sudden pain. Studies have found that SAPBs significantly lower pain levels and reduce the need for opioid medications in hospitals. Emergency doctors have successfully used this method for quick pain relief, making it particularly useful in emergency rooms. This trial will focus on training emergency medicine attending physicians and residents in ultrasound-guided nerve blocks, potentially enhancing their ability to manage pain. ^{1 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for emergency medicine attending and resident physicians looking to improve their skills in performing ultrasound-guided nerve blocks. Specifically, it's not open to ED nurses, technicians, or advanced practice physicians.

Inclusion Criteria

Emergency medicine attending and resident physicians

Exclusion Criteria

Advanced practice physicians (APPs)

I am a nurse working in the emergency department.

ED technicians

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training Workshop

Emergency medicine physicians participate in a low-fidelity simulation model workshop to learn ultrasound-guided serratus anterior nerve block

1 month

1 visit (in-person)

Follow-up

Participants are monitored for knowledge and technical skill retention through surveys at 1 month pre-intervention, post-intervention, and 3 months post-intervention

4 months

What Are the Treatments Tested in This Trial?

Interventions

• Ultrasound-guided Nerve Block Training Model and Evaluation Method

Trial Overview

The study tests a training program that teaches doctors how to do an ultrasound-guided serratus anterior nerve block using a low-fidelity simulation. It aims to standardize this training to enhance patient care through better use of point-of-care ultrasound (POCUS) and critical procedures.

How Is the Trial Designed?

Group I: Emergency Medicine attending physicians and residents Experimental Treatment 1 Intervention

Who Is Running the Clinical Trial?

Duke University

Lead Sponsor

Trials

2,495

Recruited

5,912,000+

Published Research Related to This Trial

This study, which analyzed 420 ultrasound-guided nerve blocks performed by emergency practitioners over one year, found a very low complication rate, with only one minor incident reported (arterial puncture without further issues).

Patients experienced significant pain relief, with average pain scores dropping from 7.4 to 2.8 after the procedure, indicating that ultrasound-guided nerve blocks are effective for pain management in the emergency department.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and Pain Reduction in Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study. Merz-Herrala, J., Leu, N., Anderson, E., et al.[2023]

A training curriculum for ultrasound-guided procedures, including stellate ganglion block (SGB) and intercostal nerve block (ICB), effectively improved the skills of medical students and anesthesiologists, as evidenced by increased speed and reduced attempts needed for successful procedures.

Participants rated the curriculum highly, indicating that the combination of theoretical instruction, expert demonstrations, and hands-on practice with phantoms is beneficial for teaching these techniques and enhancing medical education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comprehensive curriculum for phantom-based training of ultrasound-guided intercostal nerve and stellate ganglion blocks. Brascher, AK., Blunk, JA., Bauer, K., et al.[2022]

A one-day workshop for emergency medicine residents effectively enhanced their confidence and skills in performing ultrasound-guided regional nerve blocks (UGRNBs), which are crucial for managing pain in emergency settings.

Participants reported high satisfaction with the workshop's practical focus and expressed eagerness to apply their newly acquired skills in clinical practice, indicating the workshop's potential value in medical education.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

High-Efficiency Ultrasound-Guided Regional Nerve Block Workshop for Emergency Medicine Residents. Yonel, B., Kwak, E., Moussa, M.[2023]

A low-cost, simulation-based training program significantly improved emergency department physicians' knowledge and competence in performing ultrasound-guided nerve blocks (UGNBs), with scores rising from an average of 66.9 to 90.4 immediately after training.

While confidence in performing UGNBs increased after training, it tended to return to baseline levels after three months, indicating the need for ongoing training to maintain skills and confidence in using UGNBs in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing ultrasound-guided nerve blocks in the emergency department: A low-cost, low-fidelity training approach. Walsh, CD., Ma, IWY., Eyre, AJ., et al.[2023]

A cadaver-based education model significantly increased emergency medicine residents' confidence in performing ultrasound-guided regional anesthesia (USGRA), with comfort levels rising from 8.7% to 91.3% for general USGRA and from 9.1% to 77.3% for both the serratus anterior plane block (SAPB) and fascia iliaca compartment block (FICB).

The training also allowed instructors to identify and correct common procedural errors, such as incorrect needle placement and improper anesthetic administration, enhancing the safety and efficacy of the training process.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exploring a Cadaver-Based Model for Teaching Emergency Medicine Residents Ultrasound-Guided Serratus Anterior Plane Blocks. Wubben, BM., Wallum, MR., Wittrock, CA.[2023]

In a case series of six emergency department patients, the ultrasound-guided serratus anterior plane block (SAPB) effectively managed pain from various conditions, including severe rib fractures and herpes zoster.

The SAPB was found to be safe, with no adverse events reported in the patients, highlighting its potential as a reliable pain management technique in emergency settings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Serratus Anterior Plane Block in the Emergency Department: A Case Series. Lin, J., Hoffman, T., Badashova, K., et al.[2020]

Emergency medicine residents require a median of 1 supervised attempt to accurately identify the radial nerve, and up to 17 attempts for the ulnar nerve, indicating varying levels of difficulty in locating different nerves using ultrasound guidance.

The study found a significant association between the number of years in practice and proficiency in nerve identification, suggesting that experience plays a crucial role in developing skills for performing peripheral nerve blocks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sonographic identification of peripheral nerves in the forearm. Jackson, SA., Derr, C., De Lucia, A., et al.[2022]

A 3-hour workshop was successfully developed to train 30 participants in ultrasound-guided femoral nerve block, addressing the gap in analgesia for hip fracture patients in the Emergency Department.

Participants rated the workshop highly, with mean scores over 4.7 out of 5, indicating satisfaction and a willingness to recommend the training, suggesting it effectively met its educational objectives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Teaching ultrasound guided femoral nerve block in the emergency department. Pek, JH., Chia, WJD., Kaliannan, S., et al.[2021]

A new, low-cost simulation model for ultrasound-guided nerve blocks was developed using a pork loin, which provides a realistic feel for training purposes.

This model enhances the training experience for medical residents, helping them build confidence and tactile skills necessary for successful nerve block procedures on live patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A low cost, high fidelity nerve block model. Sparks, S., Evans, D., Byars, D.[2022]

The study involving 62 patients found that the USG-guided serratus anterior plane block (SAPB) is as effective as the thoracic paravertebral block (TPVB) in managing postoperative pain after video-assisted thoracoscopic surgery (VATS), with no significant differences in pain scores.

Patients receiving the TPVB required significantly less tramadol for pain relief, but the SAPB had a much shorter application time, making it a safe and efficient alternative for pain management in VATS.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of ultrasonography guided serratus anterior plane block and thoracic paravertebral block in video-assisted thoracoscopic surgery: a prospective randomized double-blind study. Baytar, MS., Yılmaz, C., Karasu, D., et al.[2022]

Citations

1.

mededportal.org

mededportal.org/doi/10.15766/mep_2374-8265.11454

Serratus Anterior Plane Block Remote Learning Curriculum

This project aims to create a remote conference session on ultrasound-guided serratus anterior plane blocks (USG-SAPB).

2.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC11502517/

Serratus Anterior Plane Block Remote Learning Curriculum

This project aims to create a remote conference session on ultrasound-guided serratus anterior plane blocks (USG-SAPB).

3.

sciencedirect.com

sciencedirect.com/science/article/abs/pii/S073646792500023X

Ultrasound-Guided Serratus Anterior Plane Block for Acute ...

The aim of this review was to summarize and evaluate the utility of ultrasound-guided SAPBs performed by emergency physicians for acute pain management in the ...

4.

sciencedirect.com

sciencedirect.com/science/article/abs/pii/S073646792500335X

High Utility Ultrasound Guided Nerve Blocks for ...

In this piece, we review the evidence for several high-utility nerve blocks that have been successfully used in the ED. Discussion. In this ...

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emergencymed.org.il

emergencymed.org.il/wp-content/uploads/1970/01/Ultrasound-Guided-Serratus-Anterior-Plane-Block-for-Acute-Pain-Management.pdf

Ultrasound-Guided Serratus Anterior Plane Block for Acute ...

Ultrasound-guided SAPBs per- formed by regional anesthesiologists have been shown to significantly decrease pain and opioid utilization among hospitalized ...

6.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC8138100/

Using a Simulated Model and Mastery Learning Approach to ...

This pilot study aims to teach the ultrasound‐guided SAPB to emergency medicine (EM) residents using a mastery learning approach.

7.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/40379486/

Ultrasound-Guided Serratus Anterior Plane Block for Acute ...

The aim of this review was to summarize and evaluate the utility of ultrasound-guided SAPBs performed by emergency physicians for acute pain management in the ...

8.

onlinelibrary.wiley.com

onlinelibrary.wiley.com/doi/10.1002/aet2.10912

Implementing ultrasound‐guided nerve blocks in the ...

Here we investigate the impact of a novel, cost-effective, low-fidelity UGNB educational intervention on UGNBs performed in an academic ...

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sciencedirect.com

sciencedirect.com/science/article/pii/S0735675725005297

Emergency physician-performed ultrasound-guided nerve ...

Compared with landmark-guided and nerve stimulator-guided approaches, ultrasound guidance has been shown to improve the efficacy and safety of nerve blocks [10] ...