Variability in determination of point of needle insertion in peripheral nerve blocks: A comparison of experienced and inexperienced anaesthetists

• Published in: Anaesthesia 2003-07, Vol.58 (7), p.688-692
• Main Authors: Grant, S. A., Breslin, D. S., MacLeod, D. B., Demeyts, D., Martin, G., D'Ercole, F., Hardman, D.
• Format: Article
• Language: English
• Subjects: Anaesthesia; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology - education; Anesthesiology - standards; Biological and medical sciences; Clinical Competence; Education, Medical, Graduate; Humans; Local anesthesia. Pain (treatment); Lumbosacral Plexus; Male; Medical sciences; Needles; Nerve Block - standards; nerve block, education; Peripheral nerves; Reproducibility of Results; Sciatic Nerve
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1046/j.1365-2044.2003.03189_2.x

Summary Accurate identification of surface landmarks is essential for the successful performance of peripheral nerve blocks. The variability between experienced and inexperienced practitioners in identifying anatomical landmarks has not been studied previously. Anaesthetists were asked to identify the point of needle insertion for posterior lumbar plexus and sciatic nerve blocks on a volunteer using a standard textbook description. The chosen point for needle insertion was described in terms of X and Y co‐ordinates, measured in millimetres, from a zero reference point marked on a volunteer's back. Fifteen experienced and 22 inexperienced anaesthetists took part in the study. The lumbar plexus block mean [range] values for the X, Y co‐ordinates were 80 [62–108], 66 [46–86] and 92 [49–150], 62 [0–131] in the experienced and inexperienced groups, respectively. The sciatic nerve block X, Y co‐ordinates were 77 [62–99], 70 [49–89] and 68 [29–116], 62 [26–93] in the experienced and inexperienced groups, respectively. The variance for the point of needle insertion was significantly greater in the inexperienced group (p