Phantom Study of a New Laser-Etched Needle for Improving Visibility During Ultrasonography-Guided Lumbar Medial Branch Access With Novices

Abstract

ObjectiveTo compare the visibility and procedural parameters between a standard spinal needle and a new laser-etched needle (LEN) in real-time ultrasonography guided lumbar medial branch access in a phantom of the lumbosacral spine.MethodsWe conducted a prospective single-blinded observational study at a rehabilitation medicine center. A new model of LEN was manufactured with a standard 22-gauge spinal needle and a laser etching machine. Thirty-two inexperienced polyclinic medical students performed ultrasonography-guided lumbar medial branch access using both a standard spinal needle and a LEN with scanning protocol. The outcomes included needle visibility score, needle elapsed time, first-pass success rate, and number of needle sticks.ResultsThe LEN received significantly better visibility scores and shorter needle elapsed time compared to the standard spinal needle. First-pass success rate and the number of needle sticks were not significantly different between needles.ConclusionA new LEN is expected to offer better visibility and enable inexperienced users to perform an ultrasonography-guided lumbar medial branch block more quickly. However, further study of variables may be necessary for clinical application.

Echogenic Surface Enhancements for Improving Needle Visualization in Ultrasound

“…2,5,8,20,21,24 greater angles of insertion (greater than 45 in the data analyzed in this review), "Echogenic" needles ranked higher than "Standard" needles. 1,5,[19][20][21][22]24,25…”

“…At steeper angles (greater than 45 in the data analyzed in this review), echogenic surface enhancements broadly improve needle visualization over "Standard" needles. 1,5,[19][20][21][22]24,25 Only 4 papers could reveal whether "Coated" or "Noncoated" needles were best visualized: 3 papers comparing "Coated, Noncoated, & Standard" needles (subgroup 3, Figure 6) and 1 paper comparing "Coated & Noncoated" needles (subgroup 1, Figure 4). The specifics of the 4 papers are discussed in the following 4 sections.…”

“…Yet, failure to visualize needles at steep angles (greater than 45 in the data analyzed in this review) is a recurrent problem in real-time US images and constitutes an important concern: The inability to visualize the needle may lead to complications such as nerve damage or organ injury, even when performed by experienced operators. [1][2][3] Visualization of the needle can be limited by the effects of the echoes of the needle not being fully recorded by the transducer due to the inherent angular dependency present in US imaging. 4 This is particularly pronounced with smooth-surface needles at steep angles of insertion.…”

Practical Electrochemical Method to Enhance Needle Visibility during Ultrasound Imaging

“…10,19 Previous literature has mostly used non-coated needles with limited quantities of sharp notches to obtain a similar "corner cube reflectors" effect. 20,21 However, in reality, to achieve the best reflection effect, there is a high degree of angle dependence, which places a high demand on the operator's skills. In this study, the electrolysis-induced depressions were mainly circular and numerous, and while improving the reflection efficiency, they also resulted in a linear and uniform enhancement of the ultrasound reflection on the screen, rather than a punctate enhancement, which would be more conducive to clinical operations.…”

Automatic Robotic Steering of Flexible Needles from 3D Ultrasound Images in Phantoms and Ex Vivo Biological Tissue

“…8 Refs. 16,22 describe the use of echogenic needles during ultrasound hand-guided nerve block interventions. To the best of our knowledge, none of the robotized needle steering systems used echogenic needles to achieve controlled insertion in biological tissue, and the impact of these modified needles on automatic needle detection has never been quantified.…”