Effectiveness of Simulation Models in Local Anesthesia Training

Local anesthesia (LA) administration is a fundamental component of everyday practice for the oral and maxillofacial surgeon. As one of the most important methods in which the practitioner manages patient pain during surgical procedures, it is crucial that oral and maxillofacial surgeons are competent in administering LA to patients.  Most dental schools in the United States continue to use the student-to-student injection model within their curricula and the literature reveals that LA training practices in dental schools across the United States have largely gone unchanged from 1998 to 2009^2,3. Other methods of teaching LA in dental schools have been proposed, including administering LA on human cadavers and, more recently, on simulation models¹. The aim of this study was to evaluate the effectiveness of students practicing on a LA simulation model prior administering LA for the first time in a clinical setting. To date, there are no published reports evaluating of the effectiveness of a LA simulation model on LA training in the United States.

Sixty second-year students at the Columbia University College of Dental Medicine participated in this study (approved by the IRB of Columbia University Medical Center).  The participating students had no prior experience with injecting LA. Students were randomly assigned to a control or experimental group, each consisting of 30 students. Those in the experimental group received a faculty-led tutorial with the LA simulation model and given equal opportunity to practice on the simulation model (Frasaco Company, Greenville, NC). On the following day, all 60 students administered and received an inferior alveolar nerve block to and from another student (1.8mL of 2% lidocaine w/1:100,000 epinephrine). Immediately after administering and receiving LA to and from their partner, students were asked to complete questionnaires regarding their experience.

Questions were quantified using a five-point Likert scale, ranging from 1 (“strongly agree”) to 5 (“strongly disagree”).  Investigators of the study were blind to whether students were trained on the simulation model. Students were asked not to disclose to their partners whether they trained on the LA simulation model. Data from the questionnaires were entered into SPSS and analyzed with Mann-Whitney U tests and statistical significance was set at p<0.05.

Overall, students in the experimental group exhibited a statistically significant increase in their “readiness” level when evaluating survey questions pertaining to preparedness and confidence in administering LA to another student (p<0.05). Students who received LA from those who practiced on the simulation model reported a statistically significant decrease in the amount of trismus they experienced one day post LA injection (p<0.05). Additionally, a near significant decrease in soreness at the injection site was reported by students who received LA from those who practiced on the simulation model (p=0.073).

The results of the study show that students who utilized the LA simulation model prior to injecting their classmates were more prepared and confident in administering LA from the first time in a clinical setting. Furthermore, students who received LA from those who practiced on the simulation model experienced less post-injection complications, such as trismus and soreness at the injection site. These results suggest that practicing on a simulation model prior to injecting in a clinical setting may be a valuable addition to LA training and education in oral and maxillofacial surgery.

Brand HS, Baart JA, Maas NE, Bachet I. Effect of a training model in local anesthesia training. Journal of Dental Education, 74(8):876-879, 2010.

Dower J. A survey of local anesthesia course directors. Anesthesia Progress, 45:91-95, 1998.

Rosenberg M, Orr DL, Starley ED, Jensen DR. Student-to-student local anesthesia injections in dental education: Moral, ethical and legal issues. Journal of Dental Education, 73(1):127-131, 2009.