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

100 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

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

What data supports the effectiveness of the treatment Ultrasound-guided Nerve Block Training Model and Evaluation Method, Ultrasound-guided Serratus Anterior Plane Block, USG-SAPB?

Research shows that ultrasound-guided nerve blocks, like the serratus anterior plane block, can effectively reduce pain and decrease the need for intravenous opioids in patients with rib fractures. Additionally, training emergency medicine residents using cadaver-based models significantly increased their confidence in performing these procedures. ^{1 2 3 4 5}

Is ultrasound-guided serratus anterior plane block (SAPB) safe for humans?

In a case series of six patients who received the ultrasound-guided serratus anterior plane block (SAPB) for pain management, no adverse events were reported, suggesting it is generally safe. ^{1 2 3 6 7}

How does ultrasound training for emergency medicine education differ from other treatments?

This treatment is unique because it focuses on training emergency medicine residents to use ultrasound-guided techniques for pain management, which is not commonly emphasized in emergency settings. It uses a low-cost, simulation-based approach to improve confidence and competence in performing nerve blocks, which can reduce the need for intravenous opioids and improve patient outcomes. ^{1 2 8 9 10}

What is the purpose of this trial?

The aim of this study is to assess emergency medicine physician knowledge and technical skill in performance of ultrasound-guided serratus anterior nerve block in a low-fidelity simulation model workshop and to determine the feasibility, acceptability, and usability of the training program. By performing this study, the investigators hope to create a standardized training model which could potentially facilitate POCUS and critical procedural performance and thereby improve patient care.

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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 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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Implementing ultrasound-guided nerve blocks in the emergency department: A low-cost, low-fidelity training approach. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Exploring a Cadaver-Based Model for Teaching Emergency Medicine Residents Ultrasound-Guided Serratus Anterior Plane Blocks. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Safety and Pain Reduction in Emergency Practitioner Ultrasound-Guided Nerve Blocks: A One-Year Retrospective Study. [2023]

4. India pubmed.ncbi.nlm.nih.gov

Sonographic identification of peripheral nerves in the forearm. [2022]

5. Romania pubmed.ncbi.nlm.nih.gov

Teaching ultrasound guided femoral nerve block in the emergency department. [2021]

6. United States pubmed.ncbi.nlm.nih.gov

Serratus Anterior Plane Block in the Emergency Department: A Case Series. [2020]

7. Korea (South) 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. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

High-Efficiency Ultrasound-Guided Regional Nerve Block Workshop for Emergency Medicine Residents. [2023]

9. Italy pubmed.ncbi.nlm.nih.gov

A low cost, high fidelity nerve block model. [2022]

10. England pubmed.ncbi.nlm.nih.gov

Comprehensive curriculum for phantom-based training of ultrasound-guided intercostal nerve and stellate ganglion blocks. [2022]