Mastering the Retrobulbar Block: Using a Novel 3D-printed Simulator for Practical Training

Topic The use of simulation offers a safe environment for practicing challenging and potentially dangerous techniques. We developed a 3D-printed model which realistically simulates critical orbital anatomic features and enables safe practice of the retrobulbar block (RBB). Clinical Relevance The RBB provides optimal regional anesthesia for procedures of the eye and orbit, but requires a level of hands-on training and practice which is often not readily available. Methods The simulation device was created using 3D computer modeling tools to mimic the anatomical structures, and printed with select plastic and silicone materials cast using 3D-printer generated molds. Subjects included 75 ophthalmologists with varying levels of experience who administered simulated retrobulbar anesthesia into the training model and completed pre- and post-training surveys. The primary outcomes measured were the subject’s impression of the model’s anatomical fidelity and utility for practice. Additionally, data was collected grading the participants’ successful delivery of the simulated medication injection, prior experience with retrobulbar training, and level of training in ophthalmology. Results The 3D-printed training model realistically simulated the ocular and orbital structures and enhanced the learning experience of the procedure. 17% (n=13) of participants had never previously performed an RBB. 70% (n=53) of participants recalled that performing an RBB was part of their residency training, and none had performed an RBB with a simulator. 53% (n=38) indicated that the model was similar or very similar to the actual procedure. Paired t-test analyses comparing pre-training to post- training outcomes suggested that the training improved the subjects’ level of comfort with performance of an RBB (P < 0.0001). The extent to which the participants would include or plan to include an RBB as part of their clinical practice improved between the pre-training and post-training periods (P= 0.0004). Similarly, the extent to which participants believed that using a training model would improve their clinical practice increased between the pre-training and post-training periods (P=0.0086). Conclusion Live simulation training for retrobulbar anesthesia using 3D-printed training model can realistically mimic ocular and orbital structures sufficiently to enhance acquisition of the skill and potentially improve its safe performance by ophthalmologists at all levels of experience.