P3D128: Ultrasound-guided Regional Anesthesia for the Pediatric Emergency Medicine Physician: A Novel Educational Intervention

Background: Ultrasound-guided regional anesthesia (UGRA) has proven to be a safe, effective, and opioid-sparing means of providing anesthesia in Pediatric Emergency Medicine (PEM). Despite its demonstrated utility, UGRA education and its incorporation into clinical practice in the PEM setting has been limited. We performed a needs assessment of 32 PEM providers to better understand this discrepancy. We then designed and delivered an educational workshop (1-hr lecture, 2-hr’s hands-on practice) designed at addressing these gaps.

Methods: Based on the needs assessment, the workshop was created with three primary objectives: 1) describe the potential clinical benefits of nerve blocks, 2) describe how to perform UGRA, 3) describe the precautions needed to perform nerve blocks safely. In addition to addressing these primary objectives, the workshop provided instruction on performing specific high-yield nerve blocks (forearm, posterior tibial, fascia iliaca compartment nerve block, superficial cervical plexus). In the hands-on practice portion, participants rotated through four stations in which they were able to practice identifying nerve block landmarks under the guidance of expert instructors. A post-survey was administered following the workshop.

Results: Needs

Assessment:
Thirty-two PEM providers completed the needs assessment: 3 (9.4%) residents, 11 (34.4%) fellows, 18 (56.3%) attendings. All 32 participants (100%) had received prior ultrasound education, however only 13 (40.6%) had received education in UGRA. The majority, 75% of respondents, had performed less than 5 ultrasound-guided nerve blocks in their career.

Participants were asked to identify the reasons that limit their clinical use of UGRA: 75% responded that they lacked comfort with the procedure, 28.1% responded that they lacked familiarity with the equipment required to perform the procedure, 31.3% responded that UGRA “takes too much time to perform,” and 15.6% responded that they were “not comfortable with the safety” of UGRA.

Post-Workshop Survey:
Following the workshop, 100% of participants either “agreed” or “strongly agreed” that they could describe the clinical benefits of UGRA and knew how to perform an ultrasound-guided nerve block, while 93.8% of participants either “agreed” or “strongly agreed” that they could describe the precautions needed to perform UGRA safely. Participants were asked to anticipate future obstacles to the incorporation of UGRA into their clinical practice: 40.6% cited a lack of comfort with the procedure (down 34.4% from the needs assessment), 12.5% cited a lack of familiarity with the equipment (down 15.6%), 18.8% responded that UGRA takes “too much time to perform” (down 12.5%), and 3.1% continued to cite concerns over the safety of UGRA (down 12.5%).

Conclusion: URGA is a safe and effective form of pain control in the PEM setting. Our novel educational workshop demonstrates promise as it yielded positive results in this initial cohort.