A new score for characterizing the visibility of anatomical structures during ultrasound guided regional anesthesia: a retrospective cohort study

Birnbaum, Jürgen; Diederich, Linda; Ertmer, Martin; Balzer, Felix; Hofmann, Friederike; Klotz, Edda; Trauzeddel, Ralf; Volk, Thomas; Wernecke, Klaus‐Dieter; Wismayer, Alexander; Birnbaum, Manuela; Hensel, M.

doi:10.23736/s0375-9393.20.14213-5

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…Participants had to be ≥ 18 years of age and did not attend another interventional study simultaneously. Exclusion criteria were pregnancy, preexisting nerve damages in the target area, diabetes mellitus, alcohol dependency, allergy to local anesthetics, implanted pacemaker, additionally planed spinal anesthesia and poor ultrasound visibility at the beginning of the block performance (VIS>2) as previously published by Birnbaum et al 14 Participants were randomized equally into two groups using randomization software following a block randomization list allowing an interim analysis after 10 participants each. In facet group the Uniplex needles were used and in the tuohy group the blocks were performed with needles from Arrow StimuCath 2 set.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…Before each block was performed, the target structures were identified and classified with a Visibility score (VIS). Only participants providing VIS 1 ("all structures are detected reliable immediately or after a few corrections of the ultrasound probe position" 14 ) and 2 ("the target structure detected reliable only after several corrections of the ultrasound probe" 14 ) were included in this trial. The nerve stimulator (MultiStim SWITCH, Pajunk GmbH, Geisingen, Germany) was set with 2.0mA, 2Hz and 0.1ms as initial settings.…”

Section: Interventionsmentioning

confidence: 99%

“…12; 13 Recent investigations also suggest that ultrasound imaging of the sciatic nerve at infragluteal access is worse compared to other peripheral nerves. 14 In these cases PNS could give important additional information for nerve localization to increase patient safety.…”

Section: Introductionmentioning

confidence: 99%

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Dual Guidance in Regional Anesthesia – Influence of Needle Electrode Configuration on Stimulation Success at Sciatic Nerve; A Randomized, Controlled Pilot Trial

Wegner

Ertmer

Tafelski

et al. 2022

Preprint

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Introduction In contrast to ultrasound technology (US), peripheral nerve stimulation (PNS) for regional anesthesia was little improved in recent years. When using the combination of both techniques, PNS can give additional information for nerve localization to improve safety and success of regional anesthesia. There are influencing factors on the success rate of stimulation in PNS remaining uninvestigated in a clinical setting to date. This randomized controlled pilot trial evaluates the impact of shape and size of stimulation needles electrodes under dual guidance conditions. Methods In a randomized controlled clinical trial 35 participants undergoing lower limb surgery received a preoperative proximal sciatic nerve block in dual guidance technique. Use of facet needles with point shaped electrodes (N=19, facet group) were compared with tuohy needles with large electroconductive tips (N=16, touhy group). Stimulation success at minimal distance between needle tip and nerve was recorded. Block success and complications of regional anesthesia were assessed. Results In 87% of successful stimulation (20 of 23) an ultrasound-proven contact of needle tip and sciatic nerve was necessary to elicit a motor response. More successful stimulations could performed using facet needles (84%, 16/19) compared to tuohy needles (44%, 7/16, p=0.03). If stimulation was successful the number of successful sensory blockades was increased (78%, 18/23, p=0.02). No serious complications of regional anesthesia were recorded. Discussion This pilot trial suggests that stimulation needles with small electrodes may be more reliable in indicating a contact of needle and nerve, which may improve safety and success of proximal sciatic nerve blocks.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dual Guidance in Regional Anesthesia – Influence of Needle Electrode Configuration on Stimulation Success at Sciatic Nerve; A Randomized, Controlled Pilot Trial

Wegner

Ertmer

Tafelski

et al. 2022

Preprint

Self Cite

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Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

Zhu¹,

Chanjuan²,

Zhang³

et al. 2021

Ann Palliat Med

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Background: Ultrasound guidance has become a standard method for detection of nerve structures in regional anesthesia. During ultrasound-guided blockade, to identify anatomical structures is crucial but can be challenging. In clinical practice, we find a wide difference in the visibility score of the sciatic nerve (SN) through different approaches. This study aimed to compare SNB through the anterior and above-knee lateral approach in terms of identification ease, performance efficacy, and safety.Methods: Patients scheduled for below-knee surgery were randomized to either receive SNB using the above-knee lateral approach (Group L, n=27) or the anterior approach (Group A, n=26). The primary outcome was the visibility score of SN. Secondary outcomes included the time taken to identify the SN, nerve depth, success rate of SN identification, number of needle passes, time to elicit foot flexion, needle depth, and occurrence of SNB complications. Additionally, the sensory block onset and analgesia duration were assessed.Results: We included 53 adult patients. Compared with Group A, Group L showed a higher SN visibility score [3.25 (3.17, 3.67) vs. 2.50 (1.86, 2.68), P<0.001]. The scan time was significantly shorter in Group L 8.70 (6.01) s vs. 31.54 (11.87) s, P<0.001). The depth of the SN was 3.20 (0.56) cm in Group L and 5.53 (0.84) cm in Group A (P<0.001), and the needle insertion depth was 7.15 (0.90) cm in group L and 8.32 (1.13) cm in Group A (P<0.001). The number of needle passes was less in Group L, as well as the time to elicit foot flexion, and the time taken to perform the SN block (all P<0.001). The success rate of SN identification was non-significantly higher in Group L. There was no significant between-group difference in the onset of sensory block, as well as postoperative analgesia duration. None of the approaches involved acute systemic toxicity and hematoma occurrence.Conclusions: Based on the visibility score, the above-knee lateral approach allowed easy SN identification and safe SNB. Using the ultrasound-guided above-knee lateral approach for SNB in below-knee surgeries could be a reliable choice.

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A year in review in Minerva Anestesiologica 2020. Anesthesia, analgesia, and perioperative medicine

Cavaliere¹,

Allegri²,

Apan³

et al. 2021

Minerva Anestesiol

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A new score for characterizing the visibility of anatomical structures during ultrasound guided regional anesthesia: a retrospective cohort study

Cited by 4 publications

References 14 publications

Dual Guidance in Regional Anesthesia – Influence of Needle Electrode Configuration on Stimulation Success at Sciatic Nerve; A Randomized, Controlled Pilot Trial

Dual Guidance in Regional Anesthesia – Influence of Needle Electrode Configuration on Stimulation Success at Sciatic Nerve; A Randomized, Controlled Pilot Trial

Efficacy and safety of ultrasound-guided above-knee lateral approach for popliteal sciatic nerve block in surgeries below the knee: a randomized controlled trial

A year in review in Minerva Anestesiologica 2020. Anesthesia, analgesia, and perioperative medicine

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