Modified Paramedian Versus Conventional Technique in the Residency Training: An Observational Study

National Taiwan University

Status: Completed

Conditions: Anesthesia

Treatments: Procedure: spinal anesthesia; Procedure: epidural anesthesia; Procedure: combined spinal-epidural anesthesia

Study type: Observational

Funder types: Other

Identifiers

NCT03389672

IRB200812040R

Details and patient eligibility

About

Residency training includes positive and negative aspects. Well-trained doctors must be educated, but the process may bring additional risks to patients. Anesthesiologists' performance when conducting neuraxial anesthesia is related to their experience. We hypothesized that a modified neuraxial anesthesia method would improve both residency training and patient safety.

Full description

Residency training is performed using trial and error. Several studies have shown that the training process, practice period, and resident's attitude are important factors for determining performance. During the training process, neuraxial anesthesia safety is related to the operator's experience. Ultrasound can improve resident performance; however, using ultrasound technologies in well-established training programs may not be practical for all residencies.

The paramedian approach bypasses most of the bony structures that may impede the advancement of an epidural needle in the midline approach. However, the paramedian approach requires a sharpened three-dimensional insight compared with the midline approach. We hypothesized that the higher the three-dimensional barrier, the higher the complications and number of puncture attempts. A modified paramedian approach may improve residency training and patient safety. The aim of this study was to investigate whether the modified method decreased practice attempts and patient complications.

Enrollment: 518 patients

Sex: Female

Ages: 20 to 40 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• parturients who were elective for cesarean section

Exclusion criteria

• history of allergy to the medications used in this study
• chronic or acute headaches
• possible conversion to general anesthesia
• other contraindications to practice (infection, coagulopathy, abnormal spinal anatomy, unstable vital signs, and refusal to participate in the study)

Trial design

518 participants in 3 patient groups

spinal anesthesia

Description:

The anesthesia technique were applied with modified approach and conventional approach

Treatment:

Procedure: spinal anesthesia

epidural anesthesia

Description:

The anesthesia technique were applied with modified approach and conventional approach

Treatment:

Procedure: epidural anesthesia

combined spinal-epidural anesthesia

Description:

The anesthesia technique were applied with modified approach and conventional approach

Treatment:

Procedure: combined spinal-epidural anesthesia