Safe and Sustainable: Newer Cadaver Preservation for Future Anesthesia Training

Introduction

With the growing field of regional anesthesiology requiring

anatomic expertise and ultrasound precision, cadaver

education has the potential to be a stalwart for learning.

Formaldehyde-based preservation methods are commonly

utilized, along with phenol-based and fresh-frozen methods.

- A newer embalming solution, referred to as Green,

preserves the colors, textures, and pliability of the body

tissues, and provides long term preservation of cadavers.

- Green techniques also are potentially less toxic than

formaldehyde, which is a known carcinogen.

- The non-toxic and alive-like properties of these cadavers

could prove beneficial in training for regional

anesthesiology by providing more realistic conditions for

ultrasound-guided nerve blocks.

We set out to compare the realistic qualities of the Green

cadaver and traditional cadaver when performing peripheral

nerve blocks.

Methods

- An 8-item questionnaire was developed to compare each

cadaver to a live human.

- This questionnaire was developed based upon literature

review and Inter-rater reliability.

- Ten regional anesthesiologist evaluators completed the

questionnaire.

-- Each rater performed ultrasound guided perineural

injections

- Each question was answered via a rating on a Likert scale

from 1 to 10. The gold standard (score of 10) is what one

would expect on a live patient.

- Two cadavers were studied, one preserved by the

traditional formaldehyde formulation, while the other

preserved in the Green (GreenMBalm® (Green Solutions,

Burlington, NC)) method

- Responses to each question were compared to each

other via the Kruskal-Wallis Rank Sum Test.

- An interclass correlation coefficient was also calculated

to test inter-rater reliability

Results

The Green cadaver scored higher on all eight questions per

evaluator mean and median scores. Statistically significant

differences were detected for 7/8 questions. Needle

Visualization did not show a significant difference. An

interclass correlation coefficient greater than 0.6 was

calculated, showing moderate reliability amongst raters.

Discussion

The Green cadaver appears to provide more realistic

conditions for regional nerve block procedures than the

traditional preservation method. Overall, raters found the

experience of performing ultrasound-guided nerve blocks on

the Green cadaver closer a live human. In addition to providing

better conditions for peripheral nerve block training, green

cadavers may be less toxic than formaldehyde preserved

cadavers.

Summary: Raters found the experience of

performing ultrasound-guided nerve blocks

on the Green cadaver closer a live human

compared to the traditionally embalmed

cadaver.