A new kid on the block: erector spinae plane block (espb) 'tea-trolley' teaching.

Abstract

Background and Aims ESPB's provide postoperative analgesia for patients undergoing breast, thoracic and abdominal surgery (1-3) and improve respiratory function in rib fracture patients (4,5). Lack of awareness, competence or belief in practicality are intrinsic barriers for regional anaesthesia implementation (6). 'Tea-trolley' teaching is a novel and fun modality of condensed practical skill teaching within working clinical environments (7,8). We delivered ESPB 'tea-trolley' teaching at Russells Hall Hospital (RHH) to overcome these barriers and increase ESPB provision. Methods The 'tea-trolley' teaching team attended RHH ICU and each operating theatre (day case, main and obstetric). A three minute ESPB presentation (9) was delivered (along with hot beverages/biscuits) followed by each candidate undergoing live-volunteer scanning practice and then immediate ESP mannequin needling practice. Each candidate completed pre-/postteaching surveys. Results There were 17 survey respondents; 9 consultants, 8 trainees. Pre-teaching, 76% respondents had not seen/performed an ESPB (including 8 consultants) and 65% of respondents were unaware of relevant anatomical landmarks for safe performance; post-teaching 100% respondents were aware. Pre-teaching, 82% of respondents felt either quite/ very under-confident performing an ESPB (12% felt neither confident/under-confident); post-session 88% of respondents felt either quite/very confident performing an ESPB. Of those respondents involved in management of rib fractures or breast surgery 100% responded the training would change their practice (50% 'yes definitely'/50% 'yes maybe'). Conclusions 'Tea-trolley' is a low-tech, inclusive and effective teaching modality for ESPB. Our data suggests 'tea-tolley' training is an effective modality to overcome intrinsic barriers of regional anaesthesia implementation and therefore a useful modality for teaching other regional anaesthetic techniques.