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16/03/2019

ALR en opex: 1 formation solide est nécessaire

Regional Anesthesia in the Combat Setting: Are ACGME Requirements Enough?

Dhanjal ST et Al. Mil Med. 2019 Feb 22. pii: usz007. doi: 10.1093/milmed/usz007

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Il existe un grand engouement pour la réalisation d'ALR pour la prise en charge de la douleur des blessures de guerre. Ces techniques, dont certaines sont simples, nécessitent cependant un apprentissage dont la charge est probablement sous estimée. C'est ce qu'illustre ce travail pourtant effectué dans une population censée en maîtriser tous les aspects.

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Introduction

Updated Joint Trauma System Clinical Practice Guidelines (CPG) indicate regional anesthesia and pain management (RAAPM) are important for combat casualty care. However, it is unclear whether military anesthesiology residents are receiving adequate RAAPM training to meet the CPGs. The goal of this study was to conduct a preliminary evaluation of resident-completed combat-relevant regional anesthesia procedures. It was hypothesized that most residents would perform an adequate number of each procedure to presume proficiency.

Materials and Methods

Resident-performed, combat-relevant regional anesthesia procedure frequency was extracted from a database maintained at a military anesthesiology residency program. Data collection was limited to a 1-year period. Univariate statistics described procedure distributions, frequencies, and proportion of residents achieving pre-defined, empirically-supported experience criteria for each technique. Analyses examined proportional differences in meeting experience criteria by training-year.

Results

Residents (N = 41) performed a variety of procedures. Simple procedures, such as saphenous peripheral nerve blocks, were performed at a greater frequency than more complicated procedures such as thoracic epidurals, continuous peripheral nerve blocks, and transverse abdominus plane blocks.

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The majority of residents met experience criteria for four out of the eight measured combat-relevant blocks. There were no proportional differences in meeting procedural experience criteria across the different training levels.

Conclusions

These results suggest a possible gap between the needs of the Military Health System during conflict and current residency training experiences. Reasons for this gap, as well as solutions, are explored.

 

 

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