Proficiency in interscalene anesthesia-how many blocks are necessary?

Study Objective: To determine the number of interscalene blocks that are necessary for a resident in anesthesiology to complete so as to achieve autonomous success with that specific block.

Design: Survey questionnaire of all CA1 and CA2 residents in the Department of Anesthesiology, Mount Sinai School of Medicine.

Setting: University hospital.

Measurements And Main Results: Seventeen CA-1 and CA-2 residents reported their experiences in performing interscalene blocks over an 8-month period. Data were collected regarding the number of previous attempts, technique, attending supervisor, patient weight, level of autonomy in the performance of the current block, and adequacy of the block for surgery. Eighty-two blocks were performed (1 to >15 per resident), supervised by 7 attending physicians, and 96.3% of blocks were reported as adequate for surgery. With an experience of seven to nine previous blocks, only 50% of residents were able to perform an interscalene block autonomously, whereas with >15 blocks, 87.5% reported autonomous success.

Conclusions: Experience with only 40 unspecified peripheral nerve blocks, as currently required by the Residency Review Committee as of January 2001, may not provide adequate opportunity for an individual to develop expertise in regional anesthesia.