Background and Goal of Study:
Ultrasound(US)-guided transversus abdominis plane (TAP) block becomes a popular analgesic technique for lower abdominal surgeries. A skill of hydro-dissection of TAP with local anesthetics was critical for a successful TAP block. A blue phantom is useful for practicing hand-eye coordination, but not for the skill of hydro-dissection. Pork belly has a similar three-layer muscular structure as that in human beings. We hypothesize that, used as a training phantom, pork belly could improve skill of hydro-dissection of a TAP block in novice anesthesia residents.

Materials and Methods:
Sixteen PGY-1 anesthesia residents without US-guided TAP block experience were randomized into two groups: the control group (C group) and the pork belly (PB group), each of eight. The training course consisted of two modules: a knowledge module and a second practice module. PowerPoint slides and videos were used to show (1) mechanism of sonography, (2) anatomy and sonoanatomy of TAP block, (3) and skills of hydro-dissection and image optimization in the knowledge module in both groups. In practice module, a blue phantom was used for practicing hand-eye coordination in the C group. In the PB group, a 20cm×30cm pork belly was used for practicing hand-eye coordination and hydro-dissection. The practice module would not end until all trainees reached a mastery level. Skills of hand-eye coordination and hydro-dissection were tested respectively in a 20cm×30cm pork belly in both groups. Rates of mastery of hand-eye coordination and hydro-dissection were compared between the two groups using chi-square test. A P< 0.05 was considered as statistically significant.
Results and Discussion:
Better mastery rate of hydro-dissection was observed in the PB group. An average of 7.8±2.4 trials was needed to reach a mastery level of hydro-dissection skill in the PB group. With a three-layer muscular structure, pork belly could be a good phantom to simulate anterior abdominal wall in human beings, which is useful for novice anesthesia residents to practice skill of hydro-dissection in a TAP block before their clinical practice.
Conclusion(s):
Used as a training phantom, pork belly could be useful for novice anesthesia residents to practice skill of hydro-dissection in a TAP block.


03 / Pork belly : a novel training phantom for skill of hydro-dissection in a transversus abdominis plane block in novice anesthesia residents