Assessment of the learning curve of peribulbar blocks using the Learning-Curve Cumulative Sum Method (LC-CUSUM): an observational study

Abstract

Introduction: This study aimed to assess the learning curves of peribulbar anesthesia and estimate the number of blocks needed to attain proficiency. Methods: Anonymized records of sequential peribulbar blocks performed by first-year anesthesia residents were analyzed. The block sequential number and the outcomes were extracted from each record. Success was defined as a complete sensory and motor block of the eye, and failure was defined as an incomplete block requiring supplemental local anesthetic injections or general anesthesia. Learning curves using the LC-CUSUM method were constructed, aiming for acceptable and unacceptable failure rates of 10% and 20%, and 10% probability of type I and II errors. Simulations were used to determine the proficiency limit h0. Residents whose curves reached h0 were considered proficient. The Sequential Probability Ratio Test Cumulative Sum Method (SPRT-CUSUM) was used for follow-up. Results: Thirty-nine residents performed 2076 blocks (median = 52 blocks per resident; Interquartile Range (IQR) [range] = 27–78 [4–132]). Thirty residents (77%) achieved proficiency after a median of 13 blocks (13–24 [13–24]). Conclusions: The LC-CUSUM is a robust method for detecting resident proficiency at peribulbar anesthesia, defined as success rates exceeding 90%. Accordingly, 13 to 24 supervised double-injection peribulbar blocks are needed to attain competence at peribulbar anesthesia.

Keywords

• Nerve Block/methods
• Internship and residency/methods
• Learning
• Models, Theoretical