The Construction of Learning Curve and Recommended Case Load for Training of Epidural Anesthesia in Taiwanese Patients

台灣硬膜外麻醉之學習曲線與建議執行例數之探討

錢懿(Chien I) ； 蘇理盈(Lee-Ying Soo) ； 盧奕丞(I-Chen Lu) ； 王建仁(Chien-Jen Wang) ； 陳俊道(Chun-Dao Chen) ； 彭子宏(Tee-Horng Peng) ； 湯兆舜(Chao-Shun Tang)

《疼痛醫學雜誌》 17卷1期 (2007/03) Pp. 1-7

https://doi.org/10.29792/TTJP.200703.0001

摘要

Epidural anesthesia was reported to be the most difficult manual anesthetic procedures. There are a great amount of patients received epidural blocks for analgesia or anesthesia in our hospital; hence, we designed this study to construct learning curve for epidural block and investigate case load adequate to achieve acceptable maturity of this procedure. Our study was designed to evaluate 400 lumbar epidurals performed by 4 first-year residents. The study enrolled 400 cases classified as grade 1 and 2 of spinal process landmarks. We documented the first 100 performed epidural anesthesia for each resident. For each procedure, following data were recorded and analyzed to construct learning curve and evaluate case load for training, including first-level successful rate for catheter indwelling, trying attempts and consumption time. First level success rate maintained around 90% after thirty procedures of epidural anesthesia. Mean success rate before and after thirty procedures of epidural anesthesia were 72.57% and 91.1% respectively (P＜0.001). The mean trying attempts were 1.26 (95% CI: I.18-.1.34) and 1.14 (95% CT: l.091.17) for epidural anesthesia before and after 30 procedures respectively (P＜0.05). The mean (SD) consumption time were 8.98 (0.89) and 6.12 (1.21) minutes for epidural anesthesia before and after 30 procedures respectively (P＜0.001). We concluded that after practice more than thirty cases of epidural anesthesia residents can achieve maturity of the most difficult manual anesthesiological skill in our institution. Our recommended case load for training of epidural anesthesia was thirty at least.

關鍵字

硬膜外麻醉 ； 學習曲線

並列摘要

Epidural anesthesia was reported to be the most difficult manual anesthetic procedures. There are a great amount of patients received epidural blocks for analgesia or anesthesia in our hospital; hence, we designed this study to construct learning curve for epidural block and investigate case load adequate to achieve acceptable maturity of this procedure. Our study was designed to evaluate 400 lumbar epidurals performed by 4 first-year residents. The study enrolled 400 cases classified as grade 1 and 2 of spinal process landmarks. We documented the first 100 performed epidural anesthesia for each resident. For each procedure, following data were recorded and analyzed to construct learning curve and evaluate case load for training, including first-level successful rate for catheter indwelling, trying attempts and consumption time. First level success rate maintained around 90% after thirty procedures of epidural anesthesia. Mean success rate before and after thirty procedures of epidural anesthesia were 72.57% and 91.1% respectively (P＜0.001). The mean trying attempts were 1.26 (95% CI: I.18-.1.34) and 1.14 (95% CT: l.091.17) for epidural anesthesia before and after 30 procedures respectively (P＜0.05). The mean (SD) consumption time were 8.98 (0.89) and 6.12 (1.21) minutes for epidural anesthesia before and after 30 procedures respectively (P＜0.001). We concluded that after practice more than thirty cases of epidural anesthesia residents can achieve maturity of the most difficult manual anesthesiological skill in our institution. Our recommended case load for training of epidural anesthesia was thirty at least.

並列關鍵字

Epidural anesthesia ； Learning curve