Combining Immersive Simulation with a Collaborative Procedural Training on Local Anesthetic Systemic Toxicity and Fascia Iliaca Compartment Block: A Pilot Study.

Abstract

Introduction: Readiness to perform a wide variety of procedures or manage nearly any patient presentation remains an essential aspect of emergency medicine training and practice. Often, simulation is needed to supplement real-life exposure to provide comfort and knowledge, particularly with rarer pathology and procedures. As the scope of practice continues to grow, newer procedures, such as ultrasound (US)-guided nerve blocks (UGNB), are becoming integrated into resident training, building on previously established skills. The fascia iliaca compartment block (FICB) is performed on patients with specific femoral fractures and is a now a component of standard multimodal pain regimens, with US-guidance limiting adverse events. Given the need for high volumes of local anesthetic to perform the block it is imperative for clinicians to understand dosing as well as recognize and treat local anesthetic systemic toxicity (LAST). With sparse literature on sequential immersive and procedural simulation involving intertwined topics, this presents a unique opportunity for learners.

Methods: To study the perceived knowledge and comfort with FICB and LAST, a pilot study was developed with two separate but concurrent one-hour simulations completed encompassing one of each topic over one day. We surveyed 19 learners, consisting of residents ranging from postgraduate years 1-3, prior to and immediately following completion, regarding their perceptions. We used the Stuart-Maxwell test to compare survey data.

Results: More than half of participants (56%) had not received prior formal training on FICB. There was a positive trend in perceived confidence and knowledge with visualizing relevant anatomy (4.0 [2.0-6.0] vs 9.0 [7.5-10.0], P = 0.10), performing FICB (4.0 [1.0-5.0] vs 9.0 [7.0-10.0, P = 0.08]), and perceived ability to teach their peers (3.0 [1.0-5.0] vs 8.5 [7.0-10.0], P = 0.20). Perceived ability in diagnosing and managing LAST also increased following the simulation (5.0 [3.0-6.0] vs 6.0 [6.0-7.0], P = 0.12 and 3.0 [2.0-6.0] vs 6.0 [6.0-7.0], P = 0.08, respectively).

Conclusion: Learners' perceptions of this simulation experience echo the findings of previous studies in which simulation can be used to teach procedures and pathology; of note, however, we presented a novel experience with a combination of immersive and procedural simulation.