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

Completed

• Conditions: Anesthesia
• Interventions: Procedure: spinal anesthesia; Procedure: combined spinal-epidural anesthesia; Procedure: epidural anesthesia

• Registration Number: NCT03389672
• Lead Sponsor: National Taiwan University Hospital

Brief Summary

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.

Detailed 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.

Study Timeline

• Status Verified: 2011-01
• Study Start: 2011-01-01
• Primary Completion: 2012-09-30
• Study Completion: 2012-09-30
• Study First Submitted: 2017-12-26
• Study First Submitted QC: 2018-01-02
• Last Update Submitted: 2018-01-02
• Study First Posted: 2018-01-03
• Last Update Posted: 2018-01-03

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 518

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)

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
spinal anesthesia	spinal anesthesia	The anesthesia technique were applied with modified approach and conventional approach
combined spinal-epidural anesthesia	combined spinal-epidural anesthesia	The anesthesia technique were applied with modified approach and conventional approach
epidural anesthesia	epidural anesthesia	The anesthesia technique were applied with modified approach and conventional approach

Primary Outcome Measures

Name	Time	Method
attempts	at least three days	the number of skin-to-site needle punctures

Secondary Outcome Measures

Name	Time	Method
complication	at least three days	all types of complications, including a post dura-puncture headache epidural hematoma, infection, or any unexpected neurologic injury