title: A Randomized Double-Blinded Trial on the Effects of Ultrasound Transducer Orientation on Teaching and Learning Ultrasound-Guided Regional Anesthesia.
abstract: OBJECTIVE
  Learning ultrasound-guided regional anesthesia skills, especially needle/ beam alignment, can be especially difficulty for trainees, who can often become frustrated. We hypothesized that teaching novices to orient the transducer and needle perpendicular to their shoulders will improve performance on a standardized task, compared to holding the transducer and needle parallel to the shoulders.
  
  
  METHODS
  This study compared the effects of transducer orientation on trainees' ability to complete a standardized ultrasound-guided nerve block simulation. The time to task completion and percentage of the attempt time without adequate needle visualization were measured. Participants were right-handed healthy adults with no previous ultrasound experience and were randomly assigned to training in either transducer and needle alignment in a coronal plane, parallel to the shoulders (parallel group) or transducer and needle alignment in a sagittal plane, perpendicular to the shoulders (perpendicular group). Participants used ultrasound to direct a needle to 3 targets in a standardized gelatin phantom and repeated this task 3 times. Their efforts were timed and evaluated by an assessor, who was blinded to group assignment.
  
  
  RESULTS
  Data were analyzed on 28 participants. The perpendicular group was able to complete the task more quickly (P < .001) and with a smaller proportion of time lost to inadequate needle visualization (P < .001).
  
  
  CONCLUSIONS
  Ultrasound-guided regional anesthesia trainees complete a standardized task more quickly and efficiently when instructed to hold the transducer and needle in an orientation perpendicular to their shoulders.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA.
authors.forename: Nicholas C K
authors.initials: NC
authors.lastname: Lam
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Baker
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Fishburn
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA.
authors.forename: Angie R
authors.initials: AR
authors.lastname: Hammer
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University of New Mexico, Albuquerque, New Mexico USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Petersen
authors.affiliation: Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California USA. Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California USA emariano@stanford.edu.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Mariano
mesh_terms: D000293:Adolescent; D000328:Adult; D000765:Anesthesia, Conduction / Q000379:methods*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D000072458:Orientation, Spatial; D014159:Transducers; D014465:Ultrasonics / Q000193:education* / Q000295:instrumentation; D018084:Ultrasonography, Interventional / Q000295:instrumentation* / Q000379:methods*; D055815:Young Adult
keywords: medical education; nerve block; regional anesthesia; simulation; ultrasound; ultrasound education