title: Performance accuracy of hand-on-needle versus hand-on-syringe technique for ultrasound-guided regional anesthesia simulation for emergency medicine residents.
abstract: BACKGROUND
  Ultrasound-guided nerve blocks (UGNB) are increasingly used in emergency care. The hand-on-syringe (HS) needle technique is ideally suited to the emergency department setting because it allows a single operator to perform the block without assistance. The HS technique is assumed to provide less exact needle control than the alternative two-operator hand-on-needle (HN) technique; however this assumption has never been directly tested. The primary objective of this study was to compare accuracy of needle targeting under ultrasound guidance by emergency medicine (EM) residents using HN and HS techniques on a standardized gelatinous simulation model.
  
  
  METHODS
  This prospective, randomized study evaluated task performance. We compared needle targeting accuracy using the HN and HS techniques. Each participant performed a set of structured needling maneuvers (both simple and difficult) on a standardized partial-task simulator. We evaluated time to task completion, needle visualization during advancement, and accuracy of needle tip at targeting. Resident technique preference was assessed using a post-task survey.
  
  
  RESULTS
  We evaluated 60 tasks performed by 10 EM residents. There was no significant difference in time to complete the simple model (HN vs. HS, 18 seconds vs. 18 seconds, p=0.93), time to complete the difficult model (HN vs. HS, 56 seconds vs. 50 seconds, p=0.63), needle visualization, or needle tip targeting accuracy. Most residents (60%) preferred the HS technique.
  
  
  CONCLUSIONS
  For EM residents learning UGNBs, the HN technique was not associated with superior needle control. Our results suggest that the single-operator HS technique provides equivalent needle control when compared to the two-operator HN technique.
authors.affiliation: Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California.
authors.forename: Brian
authors.initials: B
authors.lastname: Johnson
authors.affiliation: Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California.
authors.forename: Andrew
authors.initials: A
authors.lastname: Herring
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.
authors.forename: Michael
authors.initials: M
authors.lastname: Stone
authors.affiliation: Alameda Health System, Highland Hospital, Department of Emergency Medicine, Oakland, California.
authors.forename: Arun
authors.initials: A
authors.lastname: Nagdev
mesh_terms: D000328:Adult; D000776:Anesthesiology / Q000193:education; D002983:Clinical Competence; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000379:methods; D008297:Male; D008953:Models, Anatomic; D009407:Nerve Block / Q000379:methods*; D013594:Syringes; D018084:Ultrasonography, Interventional / Q000379:methods*