DP04: EFFICIENCY OF A STRUCTURED COURSE OF REGIONAL ANESTHESIA IN RESOURCE-LIMITED SETTING IN GUATEMALA.
Erika Taco-Vazquez, MD; Juan Mora, MD; Eduardo Walker-Pena, MD; Barys Ihnatsenka, MD; Steven Robicsek, MD, PhD; Federico Jimenez-Ruiz, MD
University of Florida
Introduction: Guatemala faces a significant shortage of anesthesiology-trained physicians (0.8 per 100,000 population). In response to this gap, new anesthesiology programs were established to serve rural hospitals. These have limited exposure to regional anesthesia (RA) given lack of equipment and skilled personnel. We developed an educational initiative to teach RA and point-of-care ultrasound (POCUS) to Faculty and Residents from rural hospitals, aiming to establish RA services.
Methods and Materials: Participants from three hospitals were enrolled in a 16-week training program. The program was divided into two phases. Phase one encompassed an online academic and theoretical component delivered through the USabcd platform. It gave participants one-year access to translated basic ultrasound literature and ultrasound protocols (POCUS, FAST, FATE and “plan A” regional anesthesia blocks). Participants reviewed two chapters per week, completed mandatory tests, and engaged in weekly online sessions featuring problem-based learning discussions. Phase two entailed an in-person hands-on workshop with native and fluent Spanish speaker instructors reviewing the material discussed in the previous months. Instructors visited each rural hospital and observations were made to help establish a regional anesthesia service. Emphasis was made on workflow protocols. They also supervised and supported participants in performing RA blocks.
Results: A total of 26 anesthesiologists participated in the hybrid online and in-person regional anesthesia workshop (16 residents and 10 attending physicians). Prior to the course, only 4 participants had previous exposure to regional anesthesia or ultrasound techniques. During the hands-on training, each participant performed an average of 6 blocks over three days. None of the three hospitals had implemented pre- or postoperative regional blocks prior to the intervention.
A structured examination assessed the trainees’ ability to identify anatomical landmarks, determine insertion sites, and visualize key anatomical structures. The average time to identify the supraclavicular nerve was 82 seconds, with a success rate of 95%, while the sciatic nerve at the popliteal fossa took an average of 83 seconds with a 63% success rate. Two months post-intervention, the participating hospitals collectively performed 492 blocks, demonstrating significant training knowledge retention and application.
Conclusion: Hybrid online and hands-on training proved to be an efficient method for teaching “Plan A” blocks in RA to anesthesiologists with varying levels of experience. The combination of theoretical knowledge delivered via online modules and practical, supervised application during in-person sessions provided a comprehensive training approach. Trainee engagement and the substantial number of blocks performed post-training indicate that the program successfully equipped participants with the skills and confidence to perform regional anesthesia independently.
Notably, the program demonstrated a significant impact on clinical practice, as evidenced by the rapid adoption of regional anesthesia techniques, with 492 blocks performed within two months of the intervention, in facilities where such procedures were previously absent.
Future studies should include assessments of block effectiveness, patient satisfaction, and safety outcomes to better evaluate the overall success and sustainability of such programs.