Echogenic Technology Can Improve Needle Visibility During Ultrasound-Guided Regional Anesthesia

Abstract

Needle tip visualization is fundamental to the safety and efficacy of ultrasound-guided regional anesthesia (UGRA). It can be extremely challenging especially at steep insertion angles. We assessed whether an echogenic needle improved tip visibility during UGRA by anesthesiologists performing their normal in-plane technique. The visibility of the Pajunk Sonoplex (echogenic) and the Pajunk Uniplex (control) needle were compared during 60 nerve blocks (30 femoral, 30 sciatic) in this randomized controlled trial. All ultrasound imaging was recorded for analysis. The anesthesiologist subjectively estimated the percentage time they had visualized the needle tip (5-point scale: 1 [0%-20%], 2 [20%-40%], 3 [40%-60%], 4 [60%-80%], 5 [80%-100%]). The actual time the tip was in view, angle of needle insertion, target depth, and procedure time were subsequently measured objectively by a single investigator. The Sonoplex group had both subjectively and objectively better tip visibility (P=0.002), despite having larger mean body mass index (29.0 vs 25.0 kg/m(2), P=0.01) and steeper mean insertion angle (31 vs 22 degrees, P=0.03). Objective percentage tip visibility, during in-plane UGRA, reduced by 12% for every 10-degree increase in insertion angle with the control. Tip visibility with the Sonoplex was independent of insertion angle over the range studied (0-57 degrees, P=0.95). This finding occurred when nonexpert anesthesiologists performed their standard UGRA technique. A needle that is visible for a greater percentage of time has potential safety and efficacy implications.

Assistive technology for ultrasound-guided central venous catheter placement

“…A comparison between needles commonly used in medical procedures with respect to needle visibility in ultrasound is described in Refs. [16,17]. These studies show that a more echogenic needle can improve the visibility of the needle, hence improving the safety and efficiency of the procedure.…”

Needle Trajectory and Tip Localization in Real-Time 3-D Ultrasound Using a Moving Stylus

“…The Tuohy Sono needle (Pajunk, Geisingen, Germany), for instance, has ''Cornerstone'' reflectors covering the distal portion of the cannula, creating a higher acoustic impedance compared with the surrounding tissue. Although such echogenic needles have been reported to have enhanced needle tip and shaft visibility (Deam et al 2007;Hebard and Hocking 2011;Menhadji et al 2013;Sviggum et al 2013), they typically are more expensive and represent a relatively small percentage of needles used clinically. Most standard needles in clinical use continue to be made from smooth stainless steel with steel or plastic styluses.…”

Automatic detection of a hand-held needle in ultrasound via phased-based analysis of the tremor motion

“…Examples of hardware-based methods are: analyzing the emitted signal from specialized sensors mounted on the needle, 4 power Doppler imaging to detect robot-induced needle 5 or special stylet, 6 magnetic tracking sensors to track the needle, 7 and specialized needles with added machined reflectors on the surface. 8 This group of techniques usually involves changes and/or additions of equipments to the current apparatus, which might not be easily transferable to a standard clinical work-flow.…”