Safe performance of peripheral regional anaesthesia: the significance of ultrasound guidance

Marhofer, Peter; Fritsch, Gerhard

doi:10.1111/anae.13831

Cited by 33 publications

(25 citation statements)

References 45 publications

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“…Even following the introduction of ultrasound guidance to aid regional blockade, the incidence of nerve damage seems to be unchanged . Although ultrasound gives reassurance by showing a macroscopic picture, which is useful to avoid other complications such as injections into vascular or other structures , its resolution does not allow a precise determination of the needle‐tip position with millimetric accuracy; in many cases, structures such as the nerve sheath are not clearly visible. Moreover, the alignment between the needle and ultrasound beam is often difficult and minimal unintentional displacement of the needle tip not visible with ultrasound imaging, which might occur during the injection of local anaesthetic, may result in intraneural injection.…”

Section: Introductionmentioning

confidence: 99%

The effect of rate of injection on injection pressure profiles measured using in‐line and needle‐tip sensors: an in‐vitro study

et al. 2018

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Alongside ultrasonic visualisation, measurement of injection pressure is an effective tool for reducing the risk of intraneural injection during peripheral nerve block. The aim of this study was to compare injection pressure profiles when measured along the injection line with the pressure measured directly at the needle tip using different rates of injection. A syringe pump delivered a 5-ml injection of saline into silicone gel at three different speeds (5 ml.min , 10 ml.min and 15 ml.min ). Fibreoptic pressure sensors recorded real-time pressure profiles of the injection pressure directly at the needle tip and along the injection line. A total of 15 injections were successfully performed, five for each injection rate, totalling 30 recorded pressure profiles. More rapid rates of injection caused peak pressure measured in-line to increase, whereas pressure measured at the needle tip remained constant (mean (SD) pressure in-line 30.76 (3.45) kPa vs. 72.25 (1.55) kPa and mean (SD) pressure at needle tip 19.92 (1.22) kPa vs. 20.93 (2.66) kPa at 5 ml.min and 15 ml.min , respectively). Injection pressure profiles showed that in-line pressure measurement failed to record precise real-time pressure changes occurring at the needle tip (mean (95%CI) pressure difference 10.8 (6.98-14.70) kPa vs. 51.2 (47.52-54.89) kPa for in-line and needle-tip measures, respectively). We conclude that, in order to accurately monitor the true injection pressure generated, independent from operator and injection parameters, measurement at the needle tip is necessary, as injection pressure measured along the injection line is an unreliable surrogate.

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Section: Introductionmentioning

confidence: 99%

The effect of rate of injection on injection pressure profiles measured using in‐line and needle‐tip sensors: an in‐vitro study

et al. 2018

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“…Moreover, minimal unintentional millimetric needle‐tip displacement during local anaesthetic injection can occur. Failure to accurately define the anatomical boundaries of nerves may contribute to unintentional intraneural injections, even under real‐time ultrasound guidance with in‐plane needle visualisation .…”

Section: Introductionmentioning

confidence: 99%

Real‐time continuous monitoring of injection pressure at the needle tip for peripheral nerve blocks: description of a new method

2017

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The measurement of injection pressure during the performance of peripheral nerve blocks can be pivotal to detect intraneural placement of the needle tip and thus avoid intrafascicular injection. However, injection pressure can only be measured along the injection line (tubing), which is influenced by several factors. The primary aim of this feasibility study was to describe and validate the principle of a novel nerve-block needle conceived for real-time continuous monitoring of injection pressures at the needle tip. Our secondary aim was to provide measurements and compare injection pressure values at the needle tip and in the injection line. Four porcine lower limb anatomic models were prepared and extraneural injections were performed with fractioned boluses of 2 ml saline at a controlled infusion rate of 10 ml.min (0.16 ml.s ). Injection pressure at the needle tip was monitored and compared with the pressure in the injection line. The system proved to be reliable. Thirty injections were successfully performed without technical failures. The mean (95%CI) difference between pressures at the needle tip and the injection line varied substantially from 14.33 (12.58-16.08) kPa at 0.5 ml injected volume to 41.56 (39.66-43.45) kPa at the end of the injection. This study demonstrates that the described system allows for real-time continuous monitoring of injection pressure at the needle tip. Moreover, this study shows that injection pressure values measured in the injection line cannot be assumed to be a reliable indicator of the injection pressure at the needle tip.

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“…Vários outros modelos já foram relatados como o uso de água e gelatina/ágar 9 , Blue Phantom™ 10 e os moldes que utilizam produtos orgânicos, como modelo animal 6,7 . Por outro lado, para ser considerado ideal, o simulador de ultrassom deve possuir a ecogenicidade comparável a dos tecidos humanos 6,7,9 , estar rapidamente disponível 7 , ter baixo custo 6 , possibilidade de ser utilizado repetidamente 6,7,9,10 , promover um feedback tátil 6,7,9 , manter a agulha estática 6,7,9,10 , não deixar evidente o caminho da agulha e não causar exposição a agentes nocivos à saúde 6,7,9,[10][11][12][13] . Todas essas características puderam ser observadas no modelo proposto com adaptação de gel balístico.…”

Section: Discussionunclassified

Modelo artesanal de treinamento para acesso vascular ecoguiado em adaptação de gel balístico

Rocha¹,

Rocha²,

Bengtson³

et al. 2017

PRMJ

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Este é um artigo publicado em acesso aberto (Open Access) sob a licença Creative Commons Attribution, que permite uso, distribuição e reprodução em qualquer meio, sem restrições desde que o trabalho original seja corretamente citado. Resumo Objetivo: Desenvolver um modelo de baixo custo, com fins educacionais, para treinamento de punção ecoguiada. ARTIGO DEMétodo: O fantasma é feito com uma adaptação de gel balístico utilizando água, gelatina e glicerina. Para os vasos sanguíneos, são utilizados tubos de látex (drenos Penrose) para veias e politetrafluoretileno (PTFE) para artérias. Estes são preenchidos com gel incolor e fixados no manequim. Por fim, deve-se refrigerar o molde já com a mistura, por 6 horas. Resultados: No modelo proposto foi possível treinar habilidades de punção ecoguiada. As imagens obtidas utilizando o fantasma são de alta qualidade quando comparado com a anatomia sonográfica normal. Conclusão: Este modelo é uma alternativa didática e viável economicamente para a realização de treinamento de punção ecoguiada.Descritores: ultrassonografia de intervenção; treinamento por simulação; procedimentos cirúrgicos vasculares; ecogenicidade.Summary Purpose: To develop a low cost model, with educational purposes, for ecoguide puncture training. Methods: The phantom is made with ballistic gel adaptation using water, gelatin and glycerin. For blood vessels, latex tubes are used (Penrose drains) to veins and polytetrafluoroethylene (PTFE) for arteries. These are filled with colorless gel and fixed on the mannequin. Finally, cool the mixture in the mold for 6 hours. Results: In the proposed model was possible to train ecoguied puncture skills. The images obtained using the phantom are high compared with normal sonographic anatomy. Conclusion: This model is an educational alternative and economically viable for conducting ecoguied puncture training.

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Safe performance of peripheral regional anaesthesia: the significance of ultrasound guidance

Cited by 33 publications

References 45 publications

The effect of rate of injection on injection pressure profiles measured using in‐line and needle‐tip sensors: an in‐vitro study

The effect of rate of injection on injection pressure profiles measured using in‐line and needle‐tip sensors: an in‐vitro study

Real‐time continuous monitoring of injection pressure at the needle tip for peripheral nerve blocks: description of a new method

Modelo artesanal de treinamento para acesso vascular ecoguiado em adaptação de gel balístico

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