Ultrasound-Guided Regional Anesthesia in a Resource-Limited Hospital: Prospective Pilot Study of a Hybrid Training Program

TL;DR

A hybrid training program successfully introduced ultrasound-guided regional anesthesia in a Guatemalan hospital, improving skills and clinical use.

Contribution

A practical hybrid training model for ultrasound-guided regional anesthesia in resource-limited settings is proposed and validated.

Findings

Knowledge and skill scores improved significantly after the training program.

Participants performed 187 nerve blocks over 10 months with a 96.3% success rate.

The training model increased use of regional anesthesia over general anesthesia for upper extremity surgeries.

Abstract

Ultrasound-guided regional anesthesia (UGRA) remains underused in low- and middle-income countries due to barriers to training and equipment. Recent advances in portable ultrasound devices and international partnerships have expanded access to UGRA, enhancing patient safety and quality of care.

This study describes the development and outcomes of a hybrid UGRA training program for anesthesiologists at the Hospital Nacional de Coatepeque (HNC) in Guatemala.

An educational pilot program for UGRA was developed based on local needs and feedback, comprising 4 weeks of online modules, an in-person educational conference, and 1 month of supervised clinical practice. Evaluation followed the Kirkpatrick framework using preprogram and postprogram surveys adapted from the Global Regional Anesthesia Curricular Engagement model. Outcomes included participants’ satisfaction, change in knowledge and skill, and procedural performance. Knowledge and skill assessments were compared before and after the training, and clinical data were recorded for 10 months. Nonparametric tests were used to assess changes and associations with performance outcomes.

All 7 anesthesiologists at HNC completed the training program. Knowledge test scores improved by a median percentage increase of 20.8% (IQR 13.5%-28.1%; r=0.899; P=.02), and procedural skill rating scores increased by a median percentage of 147.1% (IQR 96.9%-197.3%; r=0.904; P=.03) at 1 month and 131.4% (IQR 90.5%-172.3%; r=0.909; P=.04) at 4 months after the program. Participants self-reported high satisfaction and substantial clinical improvement and motivation. A total of 54 peripheral nerve blocks were performed under direct supervision in the first month, with 187 blocks recorded over 10 months. The supraclavicular brachial plexus block was the most frequently used (66/187, 35.3%) and replaced the standard general anesthetic for upper extremity surgery in 70 patients. The procedure success rate was 96.3% (180/187), and there were no observed patient complications.

This hybrid curriculum enabled the successful implementation of UGRA at a public hospital in Guatemala, safely expanding clinical capabilities and reducing reliance on general anesthesia for upper extremity surgery. This practical training model provides a framework for implementing UGRA in similar resource-limited hospitals.

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