Generating a learning curve for penile block in neonates, infants and children: an empirical evaluation of technical skills in novice and experienced anaesthetists.
BACKGROUND
Literature concerning learning curves for anaesthesiological procedures in paediatric anaesthesia is rare. The aim of this study was to assess the number of penile blocks needed to guarantee a high success rate in children.


METHODS
At a teaching hospital, the technical skills of 29 residents in anaesthesiology who performed penile blocks under the supervision of two staff anaesthesiologists were evaluated during a 12-month period using a standardized self-evaluation questionnaire. At the start of the study period, the residents had no prior experience in paediatric anaesthesia or in performing penile block. All residents entered the paediatric rotation after a minimum of 1-year training in adult general and regional anaesthesia. The blocks were rated using a binary score. For comparison, the success rates of the two supervising staff anaesthesiologists were collected during the same period using the same self-evaluation questionnaire. Statistical analyses were performed by generating individual and institutional learning curves by using the pooled data. The learning curves were calculated with the aid of a least square fit model. A 95% CI were estimated by a Monte Carlo procedure with a bootstrap technique.


RESULTS
In a total number of 392 blocks performed, the overall success rate was 92.1%. There was no statistical difference between the success rate of the two staff members (success rate: 96.3%) and the overall success rate of the 29 residents performing a total of 339 blocks. The total success rate for this group was 91.5%. The failure rate for the first 10 blocks performed by the residents was 8.82% (95% CI: 5.0-14.14%), it was 4.12% (95% CI: 1.13-10.22%) for the next 10 blocks and from blocks 21 to 40 it was 6.5% (95% CI: 2.65-12.9%). For blocks 41-60, the failure rate was 4.4% (95% CI 0.54-15.15%).


CONCLUSIONS
Penile block in children is easily learned by residents. A steep learning curve was found. The success rate was over 93.5% after more than 40 blocks.
Schuepfer
Guido
G
International Research Center, University of Gent, UZ Gent, Gent, Belgium.
Jöhr
Martin
M
D000328:Adult; D000776:Anesthesiology / Q000193:education*; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards*; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency; D008297:Male; D009407:Nerve Block / Q000379:methods*; D010413:Penis / Q000601:surgery*; D012655:Self-Evaluation Programs; D011795:Surveys and Questionnaires