Generating a learning curve for pediatric caudal epidural blocks: An empirical evaluation of technical skills in novice and experienced anesthetists

Background and Objectives: Learning curves for anesthesia procedures in adu lt patients have been determined, but no data are available on procedures i n pediatric anesthesia The aim of this study was to assess the number of ca udal blocks needed to guarantee a high success rate in performing caudal ep idural analgesia in children. Methods: At a teaching hospital, the technical skills of 7 residents in ane sthesiology who performed caudal blocks were evaluated during 4 months usin g a standardized self-evaluation questionnaire. At the start of the study p eriod, the residents had no prior experience in pediatric anesthesia or in performing caudal epidural blocks. All residents entered the pediatric rota tion after a minimum of 1 year of training in adult general and regional an esthesia. The blocks were rated using a binary score. For comparison, the s uccess rates of 8 experienced staff anesthesiologists were collected during the same period using the same self-evaluation questionnaire. Statistical analyses were performed by generating individual and institutional learning curves using the pooled data. The learning curves were calculated with the aid of a least-square fit model and 95% confidence intervals were estimate d by a Monte Carlo procedure with a bootstrap technique. Results: The success rate of residents was 80% after 32 procedures (95% con fidence interval of 0.59 to 1.00). The pooled success rate of the staff ane sthesiologists was 0.73 (mean) with a standard deviation of 0.45, which was not statistically different from the success rate of the residents. Conclusion: High success rates in performing caudal anesthesia in pediatric patients can be acquired after a limited number of cases. Success rates of residents learning this procedure are comparable to the results of staff a nesthesiologists.