The Construction of Learning Curve and Recommended Case Load for Training of Epidural Anesthesia in Taiwanese Patients

Epidural anesthesia was reported to be the most difficult manual anesthetic procedures. There are a great amount of patients received epidural blocks for analgesia or anesthesia in our hospital; hence, we designed this study to construct learning curve for epidural block and investigate case load adequate to achieve acceptable maturity of this procedure. Our study was designed to evaluate 400 lumbar epidurals performed by 4 first-year residents. The study enrolled 400 cases classified as grade 1 and 2 of spinal process landmarks. We documented the first 100 performed epidural anesthesia for each resident. For each procedure, following data were recorded and analyzed to construct learning curve and evaluate case load for training, including first-level successful rate for catheter indwelling, trying attempts and consumption time. First level success rate maintained around 90% after thirty procedures of epidural anesthesia. Mean success rate before and after thirty procedures of epidural anesthesia were 72.57% and 91.1% respectively (P＜0.001). The mean trying attempts were 1.26 (95% CI: I.18-.1.34) and 1.14 (95% CT: l.091.17) for epidural anesthesia before and after 30 procedures respectively (P＜0.05). The mean (SD) consumption time were 8.98 (0.89) and 6.12 (1.21) minutes for epidural anesthesia before and after 30 procedures respectively (P＜0.001). We concluded that after practice more than thirty cases of epidural anesthesia residents can achieve maturity of the most difficult manual anesthesiological skill in our institution. Our recommended case load for training of epidural anesthesia was thirty at least.