Background: Stellate ganglion block is a technically Click here to view SGB – Basic complex procedure that requires precise anatomical knowledge and advanced ultrasound (US) skills. The complexity arises from the need to accurately identify the target point for injection, which is located near critical structures such as the vertebral artery, carotid artery, jugular vein, and esophagus. Additionally,the procedure
demands meticulous needle placement and real-time visualization to avoid complications and ensure effective nerve blockade. SGB is indicated for multiple elective chronic pain syndromes such as complex regional pain syndrome, vasospastic disorders such as Raynaud’s phenomenon, and symptoms of post-traumatic stress disorder (PTSD). Urgently, SGB is used to manage refractory ventricular tachycardia (VT) in patients that do not respond to medical management and/or ablation. Since SGB is not performed frequently, in addition to standard teaching during fellowship, it is crucial to train the trainee as well as faculty JITT to ensure the provider maintain proficiency in this technically complex intervention.

Methods: This was a quality improvement project to enhance trainee proficiency in performing a SGB for inpatients with refractory VT. An US guided SGB JITT was conducted including a basic knowledge and basic Technique- module together with quick refresher reference card summarizing key point and safety measurements of the procedure. Four residents and fellows on the Acute Pain Service (APS) in the main campus of our academic center, and were asked to perform an urgent SGB for refractory VT were asked to review the video, perform ultrasound guided examination on a live model for demonstrating ergonomic considerations, positioning and probe placement as well as identification of key structures of the block. The refresher card was reviewed before performing the procedure. The measurements including capability of identification of structures by trainee, number of attempts for block, amount of verbal and “hands on” faculty intervention were captured.

Results: The JITT was implemented among four trainees on the APS (two fellows and two residents). All trainees didn’t have any experience in performing the block in a time interval of at least 4 months prior to performing the procedure. Following the implementation of JITT among four trainees, the identification of the anatomy was fast without the need for any guidance from attending. First attempt of injection was successful, no “hand on” intervention of faculty was required during the procedure. Some verbal guidance was required for 2 out of 4 procedures.

Conclusions: The implementation of Just-in-Time Training (JITT) significantly enhanced trainee proficiency in performing ultrasound-guided stellate ganglion blocks (SGB) for refractory ventricular tachycardia (VT). The focused training modules and refresher cards ensured that trainees could quickly and accurately identify critical anatomical structures, resulting in successful first-attempt injections. This quality improvement initiative demonstrates the importance of JITT in maintaining procedural competency for infrequently performed but high-stakes interventions like SGB, ultimately improving patient outcomes in urgent clinical scenarios.