ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1624205
Learning Curve of Ultrasound-Guided Caudal Epidural Block: A CUSUM Pivotal Analysis
Provisionally accepted
- Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
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Abstract Background and Objectives: This study aims to dynamically evaluate the learning curve of anesthesiology residents' mastery of ultrasound-guided caudal epidural block (US-CEB) through cumulative summation (CUSUM) analysis, providing a quantitative basis for optimizing the training program. Methods: After ethical approval and registration, 10 novice anesthesiology residents underwent standardized training in US-CEB. Over 4 months, each of 10 residents performed 30 procedures, totalling 300 cases on 300 patients undergoing perineal and sacrococcygeal surgeries. The CUSUM analysis was applied to measure performance in terms of success rates, procedural times and self-confidence score. Results: The learning curve had two phases: rapid skill acquisition followed by a plateau indicating proficiency. The median time for participants to identify landmarks was 49.5 seconds, and the US-CEB procedure took 146.6 seconds. Landmark identification skills plateaued after about 9 procedures, US-CEB skills after 11, and self-confidence after 13. Polynomial modeling showed a strong non-linear relationship between procedures and performance, with high R² values. Conclusion: The study shows that US-CEB can be learned quickly with targeted training. A structured initial training and deliberate practice help residents master ultrasound-guided sacral canal block procedures. As operators improve their skills, their confidence increases, fostering continuous development and mastery.
Keywords: Learning Curve, Ultrasound-guided, Caudal epidural block, CUSUM analysis, Teaching
Received: 07 May 2025; Accepted: 26 Aug 2025.
Copyright: © 2025 Ma, Chen and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Dongmei Ma, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
Jianhong Xu, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
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