Abstract:Regional anesthesia has been widely used in clinical practice. Over the past 30 years, various guidance techniques have been developed for regional anesthesia ranging from paresthesia progressing to neurostimulation and currently ultrasound guidance. Especially, the use of point-of-care ultrasound greatly enhances the success rate of regional anesthesia. However, the poor imaging quality of ultrasound in patients with obesity, fat infiltration, etc., limits the use of ultrasound. The combined use of ultrasound… Show more
“…(e DCEB incidence in the Us group was 9.38%, which was significantly reduced compared with the Lm group (55.56%, p < 0.001). In the Us group, the number of needle passes and attempts was significantly reduced (2 (1-4) vs. 9 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), p < 0.001; 1 (1-2) vs. 3 (1.25-5), p < 0.001), and the success rate on first needle pass was significantly increased (46.88% vs. 8.33%, p < 0.001), and the time to perform CEB was significantly reduced (1 (1-2.75) vs. 6 (2-7.75), p < 0.001). Moreover, the Us group needed more time to establish the puncture site, but there was a significant between-group difference in the total procedure (both p < 0.001).…”
Section: Ultrasound For Predictive Dceb Patientsmentioning
confidence: 98%
“…(e ultrasound technique has been applied to improve peripheral nerve blockade and central neuraxial interventions [12][13][14]. It can be used to provide sonographic images that show anatomical variations of the sacral hiatus, which is currently regarded as a gold standard for correct needle placement in the CEB technique [15,16].…”
Background. We aimed to develop a predictive difficult caudal epidural blockade (pDCEB) model when ultrasound was not available and verified the role of ultrasound in difficult caudal epidural blockade (CEB). Methods. From October 2018 to March 2019, this study consisted of three phases. First, we prospectively enrolled 202 patients scheduled to undergo caudal epidural anesthesia and assessed risk factors by binary logistic regression to develop the predictive scoring system. Second, we enrolled 87 patients to validate it. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the prediction model. Youden-index was used to determine the cut-off value. Third, we enrolled 68 patients with a high risk of difficult CEB (pDCEB score ≥3) and randomized them into ultrasound and landmark groups to verify the role of ultrasound. Result. The rate of difficult CEB was 14.98% overall 289 patients. We found a correlation between unclear palpation of the sacral hiatus (OR 9.688) and cornua (OR 4.725), the number of the sacral hiatus by palpation ≥1 (OR 4.451), and history of difficult CEB (OR 39.282) with a higher possibility of difficult CEB. The area under the receiver operating characteristic curve of the pDCEB model involving the aforementioned factors was 0.889 (95% CI, 0.827–0.952) in the development cohort and 0.862 (95% CI, 0.747–0.977) in the validation cohort. For patients with a pDCEB score ≥3, a preprocedure ultrasound scan could reduce the incidence of difficult CEB (55.56% in the Landmark group vs. 9.38% in the ultrasound group,
p
<
0.001
). Conclusion. This novel pDCEB score, which takes into account palpation of the sacral hiatus/cornua, number of the sacral hiatus by palpation ≥1, and history of difficult CEB, showed a good predictive ability of difficult CEB. The findings suggested that performing an ultrasound scan is essential for patients with a pDCEB score ≥3. Trial registration: No: ChiCTR1800018871, Site URL: https://www.chictr.org.cn/edit.aspx?pid=31875&htm=4; Principal investigator: Jialian Zhao, Date of registration: 2018.10.14.
“…(e DCEB incidence in the Us group was 9.38%, which was significantly reduced compared with the Lm group (55.56%, p < 0.001). In the Us group, the number of needle passes and attempts was significantly reduced (2 (1-4) vs. 9 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), p < 0.001; 1 (1-2) vs. 3 (1.25-5), p < 0.001), and the success rate on first needle pass was significantly increased (46.88% vs. 8.33%, p < 0.001), and the time to perform CEB was significantly reduced (1 (1-2.75) vs. 6 (2-7.75), p < 0.001). Moreover, the Us group needed more time to establish the puncture site, but there was a significant between-group difference in the total procedure (both p < 0.001).…”
Section: Ultrasound For Predictive Dceb Patientsmentioning
confidence: 98%
“…(e ultrasound technique has been applied to improve peripheral nerve blockade and central neuraxial interventions [12][13][14]. It can be used to provide sonographic images that show anatomical variations of the sacral hiatus, which is currently regarded as a gold standard for correct needle placement in the CEB technique [15,16].…”
Background. We aimed to develop a predictive difficult caudal epidural blockade (pDCEB) model when ultrasound was not available and verified the role of ultrasound in difficult caudal epidural blockade (CEB). Methods. From October 2018 to March 2019, this study consisted of three phases. First, we prospectively enrolled 202 patients scheduled to undergo caudal epidural anesthesia and assessed risk factors by binary logistic regression to develop the predictive scoring system. Second, we enrolled 87 patients to validate it. The receiver operating characteristic (ROC) curve was used to evaluate the performance of the prediction model. Youden-index was used to determine the cut-off value. Third, we enrolled 68 patients with a high risk of difficult CEB (pDCEB score ≥3) and randomized them into ultrasound and landmark groups to verify the role of ultrasound. Result. The rate of difficult CEB was 14.98% overall 289 patients. We found a correlation between unclear palpation of the sacral hiatus (OR 9.688) and cornua (OR 4.725), the number of the sacral hiatus by palpation ≥1 (OR 4.451), and history of difficult CEB (OR 39.282) with a higher possibility of difficult CEB. The area under the receiver operating characteristic curve of the pDCEB model involving the aforementioned factors was 0.889 (95% CI, 0.827–0.952) in the development cohort and 0.862 (95% CI, 0.747–0.977) in the validation cohort. For patients with a pDCEB score ≥3, a preprocedure ultrasound scan could reduce the incidence of difficult CEB (55.56% in the Landmark group vs. 9.38% in the ultrasound group,
p
<
0.001
). Conclusion. This novel pDCEB score, which takes into account palpation of the sacral hiatus/cornua, number of the sacral hiatus by palpation ≥1, and history of difficult CEB, showed a good predictive ability of difficult CEB. The findings suggested that performing an ultrasound scan is essential for patients with a pDCEB score ≥3. Trial registration: No: ChiCTR1800018871, Site URL: https://www.chictr.org.cn/edit.aspx?pid=31875&htm=4; Principal investigator: Jialian Zhao, Date of registration: 2018.10.14.
“…There are certain advantages of this technique for obese or elderly patients who have difficulty performing ultrasound-guided supra-arcuate ligament blocks or thoracic paravertebral blocks due to the poor quality of ultrasound images. 24 Figure 7 The diaphragm apposition zone block via the posterior pathway of medial arcuate ligament under direct laparoscopic visualization was performed. …”
Section: The Implementation Of Supra-arcuate Ligament Blocksmentioning
confidence: 99%
“…There are certain advantages of this technique for obese or elderly patients who have difficulty performing ultrasound-guided supra-arcuate ligament blocks or thoracic paravertebral blocks due to the poor quality of ultrasound images. 24…”
Section: Supra-arcuate Ligament Block Under Direct Laparoscopic Visualizationmentioning
Quadratus lumborum block (QLB) is clinically used for postoperative analgesia of abdominal or hip surgery, which can reduce the dose of general anesthetic, inhibit postoperative pain, and promote postoperative rehabilitation. However, accumulated studies have shown several drawbacks of QLB, such as only a small portion of local anesthetic spread into the thoracic paravertebral space, relatively longer onset time, and easily-influenced block effect by the integrity of lumbar fascia, etc. Therefore, on the basis of traditional anterior QLB, our group proposed the techniques of a supra-arcuate ligament block, which include a paramedian short-axis scanning approach, paramedian long-axis scanning approach, infra-lateral arcuate ligament QLB with the apposition zone between diaphragm and quadratus lumborum as drug diffusion target and supra-arcuate ligament block under direct laparoscopic visualization. Recent studies have demonstrated that the supra-arcuate ligament blocks have the advantages of clear anatomy, are easy to perform, and have rapid onset, which avoid some drawbacks of the conventional QLB techniques. This article reviews the anatomical basis, sonoanatomy, technical points, and clinical considerations of supra-arcuate ligament blocks.
“…Compared with other techniques, ultrasound guidance provides more intuitive and accurate nerve localization. It provides real-time images when blocking the target nerve, thus assisting the physician in achieving precise anesthesia [1]. However, ultrasound-guided brachial plexus blocks still face several challenges.…”
Brachial plexus block is a common regional anesthesia method widely used in upper limb surgery. Nowadays, ultrasound-guided brachial plexus block has been extensively used in clinical anesthesia. However, accurate brachial plexus block is highly dependent on the physician's experience, and a physician without extensive clinical experience may cause nerve injury when performing a nerve block. With the development of artificial intelligence technology, the deep learning method can automatically identify the brachial plexus in ultrasound images and assist doctors in completing the brachial plexus block accurately and quickly. In this paper, we aim to evaluate the performance of different deep learning models in identifying brachial plexus (i.e., segmentation of brachial plexus) from ultrasonic images to explore the best models and training strategies for this task. To this end, we use a new dataset containing 340 brachial plexus ultrasound images annotated by three experienced clinicians. Among the 12 deep learning models we evaluated, U-Net achieves the best segmentation accuracy, with an intersection over union (IoU) of 68.50%. However, the number of U-Net parameters is very large, and it can only process 15 images per second. Compared to U-Net, LinkNet can process 142 images per second and achieve the second-best segmentation accuracy with an IoU of 66.27%. It achieves the balance between segmentation accuracy and processing efficiency, which has a good potential for the brachial plexus's real-time segmentation task.
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