This work was supported in part by an Education and Research Fund, Department of Anesthesiology and Pain Medicine, University of Alberta Hospitals, Edmonton, Canada. BCT is supported by a Clinical Investigator Award from the Alberta Heritage Foundation for Medical Research.
Learning the ‘traceback’ approach for interscalene block
Article first published online: 9 DEC 2013
© 2013 The Association of Anaesthetists of Great Britain and Ireland
Volume 69, Issue 1, pages 83–85, January 2014
How to Cite
Tsui, B. C. and Lou, L. (2014), Learning the ‘traceback’ approach for interscalene block. Anaesthesia, 69: 83–85. doi: 10.1111/anae.12556
- Issue published online: 9 DEC 2013
- Article first published online: 9 DEC 2013
Numerous simulation and training methods have been described to improve inexperienced anaesthesiology practitioners' learning of ultrasound-guided techniques, including accurate needle placement , types of transducer , and needle visualisation . A dynamic ‘traceback’ method has been described and used successfully at our institution for locating the interscalene brachial plexus , but this approach has not yet been validated. We compared the dynamic traceback approach with the local sonoanatomy landmark approach (using the cricoid as a landmark) for identifying the brachial plexus in the interscalene groove. We hypothesised that a dynamic, stepwise method such as the traceback approach would yield greater success compared with the local sonoanatomy landmark approach.
Eleven anaesthesiology residents with no prior ultrasound-guided regional anaesthesia experience were randomly assigned, using sealed envelopes containing written instructions, to one of the approaches described in Fig. 1. The residents had five minutes to read the instructions and were given a timed (maximum of 5 min) attempt to obtain a clear ultrasound image of the brachial plexus on a naive volunteer model (BMI 20.6 kg.m−2). After one hour, each resident was given sealed instructions for the other approach, and the procedure was repeated. A portable TITAN ultrasound machine (SonoSite Inc., Bothell, WA, USA) with a C11e, 11 mm footprint, 8–5 MHz probe was used for scanning .
On the first attempt, 1/6 (16.7%) residents using the local sonoanatomy landmark approach successfully obtained a clear image of the brachial plexus at the interscalene level, compared with 5/5 of the residents (100%) using the traceback method. On the second attempt, 2/5 (40%) of those using the local sonoanatomy landmark method were successful, compared with 6/6 (100%) residents using the traceback approach.
Compared with the local sonoanatomy landmark method, residents using the traceback method were able to obtain acceptable images of the brachial plexus at the interscalene level with a high degree of success. The traceback approach may be a useful training aid for practitioners who have little or no experience in ultrasound-guided regional anaesthesia.
The author wishes to thank Dr Brendan Finucane, Dr Ravi Bhargava, and Jennifer Pillay for assistance with the study and D. Gareth Corry for assistance with manuscript preparation.
- 4Atlas of Ultrasound and Nerve Stimulation-Guided Regional Anesthesia. New York, Springer, 2007. p. 68..