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

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

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.

Study Overview

• Status: Unknown
• Conditions: Single-handed Ultrasound-guided Regional Anaesthesia Grip; Single-operator Ultrasound-guided Peripheric Nerve Block; Anesthesiology Training; Jedi Grip
• Intervention / Treatment: Other: reaching targeted area on the phantom model

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Anticipated): 50
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Ankara, Turkey, 06600
    • Ankara City Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 24 years to 40 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

- To be a junior resident of anesthesiology(< 2 years )

Exclusion Criteria:

• Refusal of resident

Study Plan

How is the study designed?

Design Details

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

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Double Operator Ultrasound-Guided Regional Anesthesia; 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; resident reach the targeted area on the phantom model using ultrasoun guidance and independently or with asistance inject the solution
Active Comparator: Jedi Grip; 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; resident reach the targeted area on the phantom model using ultrasoun guidance and independently or with asistance inject the solution
Active Comparator: On-lock grip; 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; resident reach the targeted area on the phantom model using ultrasoun guidance and independently or with asistance inject the solution
Active Comparator: Bedforth alternative grip; 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; resident reach the targeted area on the phantom model using ultrasoun guidance and independently or with asistance inject the solution

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Ankara City Hospital Bilkent
• Investigators: Principal Investigator: İsmail Aytac, Ankara City Hospital Anesthesiology Department

Publications and helpful links

General Publications

• Pappin D, Christie I. The Jedi Grip: a novel technique for administering local anaesthetic in ultrasound-guided regional anaesthesia. Anaesthesia. 2011 Sep;66(9):845. doi: 10.1111/j.1365-2044.2011.06845.x. No abstract available.
• Gupta P, Berrill A. 'On lock' - a further single-operator ultrasound-guided regional anaesthesia grip. Anaesthesia. 2017 Oct;72(10):1289. doi: 10.1111/anae.14050. No abstract available.
• Bedforth N, Townsley P, Maybin J, Eisenberg E. Single-handed ultrasound-guided regional anaesthesia. Anaesthesia. 2011 Sep;66(9):846. doi: 10.1111/j.1365-2044.2011.06864.x. No abstract available.
• Miyake S. Factors influencing mental workload indexes. J UOEH. 1997 Dec 1;19(4):313-25. doi: 10.7888/juoeh.19.313.
• Guven Aytac B, Unal S, Aytac I. A randomized, controlled simulation study comparing single and double operator ultrasound-guided regional nerve block techniques using a gelatine-based home-made phantom. Medicine (Baltimore). 2022 Sep 2;101(35):e30368. doi: 10.1097/MD.0000000000030370.

Study record dates

Study Major Dates

• Study Start (Actual): July 1, 2020
• Primary Completion (Anticipated): September 15, 2020
• Study Completion (Anticipated): October 1, 2020

Study Registration Dates

• First Submitted: July 17, 2020
• First Submitted That Met QC Criteria: July 22, 2020
• First Posted (Actual): July 27, 2020

Study Record Updates

• Last Update Posted (Actual): July 27, 2020
• Last Update Submitted That Met QC Criteria: July 22, 2020
• Last Verified: July 1, 2020

More Information

Terms related to this study

• Keywords: Jedi Grip; single-operator ultrasound-guided regional anaesthesia grip; Single-handed ultrasound-guided regional anaesthesia; 'On lock' grip; Anesthesiology training
• Additional Relevant MeSH Terms: RNA Virus Infections; Virus Diseases; Infections; Respiratory Tract Infections; Respiratory Tract Diseases; Orthomyxoviridae Infections; Influenza, Human
• Other Study ID Numbers: E1/20-804

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: No

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No