Article

Optimizing the safety and practice of ultrasound-guided regional anesthesia: the role of echogenic technology.

aSchool of Medicine and Pharmacology, The University of Western Australia bSir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Current opinion in anaesthesiology 07/2012; 25(5):603-9. DOI: 10.1097/ACO.0b013e328356b835
Source: PubMed

ABSTRACT Significant improvements have been made in the quality of ultrasound imaging, and it is now much easier to see nerves. However, the key to safe ultrasound-guided regional anesthesia is to be able to direct the needle to the target. This relies on good needle visibility. We review the recent advances that have been made in this crucial area.
Echogenic needles can improve shaft and tip visibility independent of experience level, compensate for suboptimal scanning technique, allow steeper insertion angles, reduce technical difficulty, and increase both confidence and satisfaction by anesthesiologists. An echogenic needle encourages holding the probe in one place on the patient, only advancing the needle when it can be seen, hence reducing the likelihood of quality-compromising behaviors. The poor visibility of nonechogenic needles when inserted at steeper angles commonly causes the observer to underestimate the insertion depth of the needle. Significant differences in echogenicity are found when comparing the currently available needles.
Good echogenic needles should increase safety, efficacy, and simplicity, and hopefully further drive the adoption of ultrasound-guided techniques, to the benefit of our patients.

0 Bookmarks
 · 
81 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Real-time ultrasound guidance for any intervention relies on visualization of needle advancement towards a target. Unfortunately, correct identification of the needle tip is not straightforward, as artifacts always distort the image. The ultrasonic appearance of the needle is often degraded by reverberation, comet tail, side-lobe, beam-width, or bayonet artifacts, which can easily confuse an unprepared operator. Furthermore, the typical needle image, that is, a dot or a straight line (out-of-plane and in-plane approaches, respectively), is also a result of artifacts that hide the real dimensions of the needle. Knowledge and correct interpretation of these artifacts is important for safe practice and is paramount to success when precise needle manipulation is mandatory, for example, when the target is small. In this review, authors discuss the most important needle-related artifacts and provide a physical explanation focusing on implications for everyday practice. Recent advances that allow increased needle visualization and reduction of artifacts are also discussed.
    BJA British Journal of Anaesthesia 02/2014; · 4.24 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Visibility of the needle tip and shaft is important during ultrasound-guided regional anaesthesia in order to prevent nerve trauma. Tip and shaft visibility is reduced when needles are inserted in-plane at wide angles and out-of-plane at narrow angles to the ultrasound probe. Although textured needles are more reflective than smooth needles, we hypothesised that poor visibility of the tip and shaft still remained using the above angle-probe combinations. In a single-blind study, we compared the visibility of a textured Tuohy needle, a textured single-shot needle and a conventional smooth-surfaced Tuohy needle when inserted into the biceps and deltoid muscles of a soft embalmed cadaver. One hundred and forty-four needles were block-randomised to in-plane and out-of-plane insertions at 30°, 45°, 60° and 75° to the ultrasound beam. Two blinded raters assessed needle tip visibility on video recordings of the insertions using a binary scale (0 = not visible, 1 = visible) and shaft visibility using a 5-point Likert scale. The median (IQR [range]) proportions of visible needle tips were 83% (67–83 [50–100]%) for the textured Tuohy, 75% (67–83 [33–83]%) for the textured single-shot needle and 33% (33–46 [0–50]%) for the smooth-surfaced Tuohy (p = 0.0007). Median (IQR [range]) needle shaft visibility was rated as 4.0 (3.5–4.7 [3.0–4.9]) for the textured Tuohy, 4.0 (3.8–4.5 [2.7–4.9]) for the textured single-shot needle and 3.0 (2.4–3.3 [2.3–3.5]) for the smooth-surfaced Tuohy (p = 0.015). Nevertheless, visibility was reduced at wide angles in-plane and narrow angles out-of-plane both for needle tips (p = 0.004) and shafts (p = 0.005).
    Anaesthesia 11/2014; · 3.49 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Over the last decades, the number of total knee arthroplasty procedures performed in the United States has been increasing dramatically. This very successful intervention, however, is associated with significant postoperative pain, and adequate postoperative analgesia is mandatory in order to allow for successful rehabilitation and recovery. The use of regional anesthesia and peripheral nerve blocks has facilitated and improved this goal. Many different approaches and techniques for peripheral nerve blockades, either landmark or, more recently, ultrasound guided have been described over the last decades. This includes but is not restricted to techniques discussed in this review. The introduction of ultrasound has improved many approaches to peripheral nerves either in success rate and/or time to block. Moreover, ultrasound has enhanced the safety of peripheral nerve blocks due to immediate needle visualization and as consequence needle guidance during the block. In contrast to patient controlled analgesia using opioids, patients with a regional anesthetic technique suffer from fewer adverse events and show higher patient satisfaction; this is important as hospital rankings and advertisement have become more common worldwide and many patients use these factors in order to choose a certain institution for a specific procedure. This review provides a short overview of currently used regional anesthetic and analgesic techniques focusing on related implications, considerations and outcomes.
    World journal of orthopedics. 07/2014; 5(3):225-32.

Full-text

Download
31 Downloads
Available from
May 21, 2014