تجزیه و تحلیل وظیفه ارگونومیک بلوک عصب فمورال هدایت شونده اولتراسوند: یک مطالعه آزمایشی

Study Objective To apply ergonomic task analysis to the performance of ultrasound-guided (US-guided) femoral nerve block (FNB) in an acute hospital setting. Design Pilot prospective observational study. Setting Orthopedic operating room of a regional trauma hospital. Subjects 15 anesthesiologists of various levels of experience in US-guided FNB (estimated minimum experience < 10 procedures; maximum about 50 procedures, and from basic trainees to consultants); and 15 patients (5 men and 10 women), aged 77 ± 15 (mean ± SD yrs) years. Measurements/Observations A data capture “tool”, which was modified from one previously developed for ergonomic study of spinal anesthesia, was studied. Patient, operator, and heterogeneous environmental factors related to ergonomic performance of US-guided FNB were identified. The observation period started immediately before commencement of positioning the patient and ended on completion of perineural injection. Data were acquired using direct observations, photography, and application of a questionnaire. Main Results The quality of ergonomic performance was generally suboptimal and varied greatly among operators. Eight (experience < 10 procedures) of 15 operators excessively rotated their head, neck, and/or back to visualize the image on the ultrasound machine. Eight operators (experience < 10 procedures) performed the procedure with excessive thoracolumbar flexion. Conclusion Performance of US-guided FNB presents ergonomic challenges and was suboptimal during most of the procedures observed. Formal training in US-guided peripheral nerve blockade should include reference to ergonomic factors.

Ergonomics is the science of physical interaction between humans and their working environment, while “human factors engineering” is the study of underlying cognitive elements responsible for such interaction. The application of ergonomic strategies requires the study of body mechanics, the nature of the work performed, and the individual performance of a worker. When successfully applied, such strategies may optimize system performance while maximizing human well-being and operational effectiveness. Ergonomics also embraces a range of issues relevant to equipment or systems design and training: motion and strength capabilities (biomechanics), sensory-motor capabilities—vision, hearing, haptics (force and touch), and dexterity [1]. Due to advances in medical knowledge and biomedical technology and the expectations of the society, medical professionals currently work in complex and demanding environments. One example of this is the work of an anesthetist/anesthesiologist in a modern operating room (OR). Although ultrasound-guided (US-guided) peripheral nerve blockade is now widely practiced and its use is likely to increase further, most ORs have not been modified according to the requirements of US-guided peripheral nerve blockade. As the operators performing this technique respond to visual, haptic, and auditory input from multiple sources, the procedure presents an ergonomic and clinical challenge, especially in an environment that has not been designed or prepared for these procedures. There is growing recognition of the relevance of ergonomics to surgery and anesthesia practice [2] and [3]. To date, ergonomics is not taught in most anesthesiology training programs although the potential benefits of such teaching have been recognized [4], [5] and [6]. Evidence exists that even simple and short surgical procedures carry occupational hazards if ergonomic principles are overlooked [7]. The first step in identifying a need to change practice or training was to perform a preliminary observational pilot study of anesthesiologists' ergonomic performance in a “real world” clinical setting. The principal objective of this pilot study was to apply ergonomic task analysis to performance of US-guided femoral nerve block (FNB) in a busy acute hospital setting [8].

Performance of US-guided FNB presents ergonomic challenges and was suboptimal during most of the procedures observed. Formal training in US-guided peripheral nerve blockade should include reference to ergonomic factors.