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BJA Advance Access published online on December 24, 2004
British Journal of Anaesthesia, doi:10.1093/bja/aei060
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Accepted October 22, 2004

Laboratory Investigation

Use of three-dimensional animation for regional anaesthesia teaching: application to interscalene brachial plexus blockade{dagger}

M. W. Lim 1*, G. Burt 1, and S. V. Rutter 1

1 Nuffield Department of Anaesthetics, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, UK

* To whom correspondence should be addressed.
M. W. Lim, E-mail: michael.lim{at}ntlworld.com


  Abstract

Background. Using commercial computer graphics software (TrueSpace), we constructed a virtual-reality model for teaching interscalene brachial plexus block. This tool combines the clarity of schematic drawings and the clinical relevance of video clips and live demonstrations. The aim is to accelerate learning and aid retention of relevant information.

Method. We made a series of continuous short virtual-reality animations demonstrating the steps to perform an interscalene block. Superficial structures were made transparent to show the anatomical relevance of landmarking and needle manipulation. The clips were presented to delegates at a training course in Oxford. Delegates were surveyed to ascertain whether or not the presentation enhanced their understanding of anatomy and regional block technique. Before and after the presentation, delegates indicated surface landmarking, needle angulation, and movement on photographs of the lateral and anterolateral neck views of two volunteers. The markings were analysed by two independent assessors and rated as ‘good’, ‘bad’, or ‘ungradeable’. The percentage improvement for each skill group was calculated and McNemar's test applied.

Results. Of 24 respondents, the majority thought that the presentation enhanced their understanding of the anatomical (87.5%) and technical principles (79.2%) of interscalene blocks. Analysis of the marked photographs showed an overall 24.1% improvement in landmarking skills after the teaching presentation (P<0.001). Changes were significant in moderately experienced skill groups (P<0.001) but not for the very experienced (P>0.5) and the inexperienced skill groups (P<0.1). There was 76.3% concordance in scoring between the two assessors.

Conclusion. Three-dimensional animation is a promising new tool to accelerate the learning of regional anaesthetic techniques.

Keywords: anaesthetic techniques, regional; computers; teaching.
{dagger}This paper has been presented at the 13th World Congress of Anaesthesiologists, Paris, April 2004. The abstract is published in the accompanying CD-ROM under reference S028. This paper has also been presented at the Society of Computing and Technology in Anaesthesia Winter Meeting, Manchester, November 2003 and at the National Anaesthetic Research Meeting, Penrith, June 2004.
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