The Lumbar and Sacral Plexus and Their Role in Anesthesia

Bolin, Niki
Whitcomb, Emily
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In the Fall Semester of 2012, the Nurse Anesthesia Class of 2014 was introduced for the first time peripheral nerve blocks (PNBs) of the lower extremity. Although lots of time was dedicated to the PNB procedures and ultrasound technique, the class spent several hours self-studying the anatomy and physiology. This included reviewing approximately six to seven chapters in the Hadzic Regional Anesthesia Textbook. In efforts to aid in this described problem, the authors of this capstone project created a learning module that was presented to the Class of 2015. This module, which included an extensive literature review and PowerPoint presentation about regional anesthesia of the lumbar and sacral plexus including the anatomy, technique, complications, and clinical importance, was introduced to the Class of 2015 during their third semester on November 11, 2013. To evaluate the success of this capstone project, a 19 question pre and post-test was administered to 22 students. In addition, the same test was administered 12 weeks later to help determine recall on this topic. The results demonstrated that test scores increased with each subsequent administration from an approximate mean score of 56.1% to 77.5%. Following the completion of the pre-test, post-test 1, and post-test 2, a statistical analysis was completed in efforts to determine significant outcomes. A One-Way Analysis of Variance (ANOVA) showed a statistical significance of p < 0.05 at a p-value of 0.009. This led to an additional statistical analysis using a post hoc multiple comparison. Even though the mean scores increased with each subsequent test, post hoc comparisons indicated that a significant difference could only be found between mean scores of Pre-test and Post-Test 2 (p = .002). This result proved to be an interesting finding. There could be several factors responsible for the improved mean test scores. Students had 12 weeks between the presentation and post-test 2. During this time, students received an additional exposure to the material through an ultrasound-simulation lab, completion of assigned reading, and examination preparation. In addition, some students may have received exposure to lower extremity PNBs during their clinical rotations. These could all contribute to the limitations of the statistical analysis. The literature review completed for this capstone demonstrated the importance of lower extremity PNBs to anesthesia providers and the importance of classroom exposure to the anatomy and physiology of these nerve blocks. The goal of this capstone project was to aid in the classroom portion of SRNA’s education on lower extremity PNBs. The Likert Scale survey, administered by the authors of this project and with anonymously reported results, indicated students at ADU believes that the information presented is essential in their mastery of this material and that this material should continue to be presented in subsequent years.