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Swain BP, Nag DS, Anand R, Kumar H, Ganguly PK, Singh N. Current evidence on artificial intelligence in regional anesthesia. World J Clin Cases 2024; 12:6613-6619. [DOI: 10.12998/wjcc.v12.i33.6613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 09/11/2024] [Accepted: 09/19/2024] [Indexed: 09/27/2024] Open
Abstract
The recent advancement in regional anesthesia (RA) has been largely attributed to ultrasound technology. However, the safety and efficiency of ultrasound-guided nerve blocks depend upon the skill and experience of the performer. Even with adequate training, experience, and knowledge, human-related limitations such as fatigue, failure to recognize the correct anatomical structure, and unintentional needle or probe movement can hinder the overall effectiveness of RA. The amalgamation of artificial intelligence (AI) to RA practice has promised to override these human limitations. Machine learning, an integral part of AI can improve its performance through continuous learning and experience, like the human brain. It enables computers to recognize images and patterns specifically useful in anatomic structure identification during the performance of RA. AI can provide real-time guidance to clinicians by highlighting important anatomical structures on ultrasound images, and it can also assist in needle tracking and accurate deposition of local anesthetics. The future of RA with AI integration appears promising, yet obstacles such as device malfunction, data privacy, regulatory barriers, and cost concerns can deter its clinical implementation. The current mini review deliberates the current application, future direction, and barrier to the application of AI in RA practice.
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Affiliation(s)
- Bhanu Pratap Swain
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
- Department of Anesthesiology, Manipal Tata Medical College, Jamshedpur 831017, India
| | - Deb Sanjay Nag
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
| | - Rishi Anand
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
- Department of Anesthesiology, Manipal Tata Medical College, Jamshedpur 831017, India
| | - Himanshu Kumar
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
- Department of Anesthesiology, Manipal Tata Medical College, Jamshedpur 831017, India
| | | | - Niharika Singh
- Department of Anaesthesiology, Tata Main Hospital, Jamshedpur 831001, India
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Jacobs E, Wainman B, Bowness J. Applying artificial intelligence to the use of ultrasound as an educational tool: A focus on ultrasound-guided regional anesthesia. ANATOMICAL SCIENCES EDUCATION 2024; 17:919-925. [PMID: 36880869 DOI: 10.1002/ase.2266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 02/10/2023] [Accepted: 02/25/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Emma Jacobs
- Department of Anaesthesia, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
| | - Bruce Wainman
- Education Program in Anatomy, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Science, McMaster University, Hamilton, Ontario, Canada
| | - James Bowness
- Department of Anaesthesia, Royal Gwent Hospital, Aneurin Bevan University Health Board, Newport, UK
- OxSTaR Center, Nuffield Division of Anaesthetics, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Marino M, Hagh R, Hamrin Senorski E, Longo UG, Oeding JF, Nellgard B, Szell A, Samuelsson K. Artificial intelligence-assisted ultrasound-guided regional anaesthesia: An explorative scoping review. J Exp Orthop 2024; 11:e12104. [PMID: 39144578 PMCID: PMC11322584 DOI: 10.1002/jeo2.12104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 08/16/2024] Open
Abstract
Purpose The present study reviews the available scientific literature on artificial intelligence (AI)-assisted ultrasound-guided regional anaesthesia (UGRA) and evaluates the reported intraprocedural parameters and postprocedural outcomes. Methods A literature search was performed on 19 September 2023, using the Medline, EMBASE, CINAHL, Cochrane Library and Google Scholar databases by experts in electronic searching. All study designs were considered with no restrictions regarding patient characteristics or cohort size. Outcomes assessed included the accuracy of AI-model tracking, success at the first attempt, differences in outcomes between AI-assisted and unassisted UGRA, operator feedback and case-report data. Results A joint adaptive median binary pattern (JAMBP) has been applied to improve the tracking procedure, while a particle filter (PF) is involved in feature extraction. JAMBP combined with PF was most accurate on all images for landmark identification, with accuracy scores of 0.83, 0.93 and 0.93 on original, preprocessed and filtered images, respectively. Evaluation of first-attempt success of spinal needle insertion revealed first-attempt success in most patients. When comparing AI application versus UGRA alone, a significant statistical difference (p < 0.05) was found for correct block view, correct structure identification and decrease in mean injection time, needle track adjustments and bone encounters in favour of having AI assistance. Assessment of operator feedback revealed that expert and nonexpert operator feedback was overall positive. Conclusion AI appears promising to enhance UGRA as well as to positively influence operator training. AI application of UGRA may improve the identification of anatomical structures and provide guidance for needle placement, reducing the risk of complications and improving patient outcomes. Level of Evidence Level IV.
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Affiliation(s)
- Martina Marino
- Fondazione Policlinico Universitario Campus Bio‐MedicoVia Alvaro del PortilloRomaItaly
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and SurgeryUniversità Campus Bio‐Medico di Roma, Via Alvaro del PortilloRomaItaly
| | - Rebecca Hagh
- Sahlgrenska Sports Medicine CenterGothenburgSweden
| | - Eric Hamrin Senorski
- Sahlgrenska Sports Medicine CenterGothenburgSweden
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio‐MedicoVia Alvaro del PortilloRomaItaly
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and SurgeryUniversità Campus Bio‐Medico di Roma, Via Alvaro del PortilloRomaItaly
| | - Jacob F. Oeding
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- School of MedicineMayo Clinic Alix School of MedicineRochesterMinnesotaUSA
| | - Bengt Nellgard
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Anita Szell
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Kristian Samuelsson
- Sahlgrenska Sports Medicine CenterGothenburgSweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
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Bowness JS, Metcalfe D, El-Boghdadly K, Thurley N, Morecroft M, Hartley T, Krawczyk J, Noble JA, Higham H. Artificial intelligence for ultrasound scanning in regional anaesthesia: a scoping review of the evidence from multiple disciplines. Br J Anaesth 2024; 132:1049-1062. [PMID: 38448269 PMCID: PMC11103083 DOI: 10.1016/j.bja.2024.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/09/2024] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI) for ultrasound scanning in regional anaesthesia is a rapidly developing interdisciplinary field. There is a risk that work could be undertaken in parallel by different elements of the community but with a lack of knowledge transfer between disciplines, leading to repetition and diverging methodologies. This scoping review aimed to identify and map the available literature on the accuracy and utility of AI systems for ultrasound scanning in regional anaesthesia. METHODS A literature search was conducted using Medline, Embase, CINAHL, IEEE Xplore, and ACM Digital Library. Clinical trial registries, a registry of doctoral theses, regulatory authority databases, and websites of learned societies in the field were searched. Online commercial sources were also reviewed. RESULTS In total, 13,014 sources were identified; 116 were included for full-text review. A marked change in AI techniques was noted in 2016-17, from which point on the predominant technique used was deep learning. Methods of evaluating accuracy are variable, meaning it is impossible to compare the performance of one model with another. Evaluations of utility are more comparable, but predominantly gained from the simulation setting with limited clinical data on efficacy or safety. Study methodology and reporting lack standardisation. CONCLUSIONS There is a lack of structure to the evaluation of accuracy and utility of AI for ultrasound scanning in regional anaesthesia, which hinders rigorous appraisal and clinical uptake. A framework for consistent evaluation is needed to inform model evaluation, allow comparison between approaches/models, and facilitate appropriate clinical adoption.
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Affiliation(s)
- James S Bowness
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK.
| | - David Metcalfe
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK; Emergency Medicine Research in Oxford (EMROx), Oxford University Hospitals NHS Foundation Trust, Oxford, UK. https://twitter.com/@TraumaDataDoc
| | - Kariem El-Boghdadly
- Department of Anaesthesia and Peri-operative Medicine, Guy's & St Thomas's NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK. https://twitter.com/@elboghdadly
| | - Neal Thurley
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Megan Morecroft
- Faculty of Medicine, Health & Life Sciences, University of Swansea, Swansea, UK
| | - Thomas Hartley
- Intelligent Ultrasound, Cardiff, UK. https://twitter.com/@tomhartley84
| | - Joanna Krawczyk
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - J Alison Noble
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK. https://twitter.com/@AlisonNoble_OU
| | - Helen Higham
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. https://twitter.com/@HelenEHigham
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Baizhanova A, Zhailauova A, Sazonov V. Regional anesthesia for pain control in children with solid tumors-a review of case reports. Front Pediatr 2024; 11:1275531. [PMID: 38274469 PMCID: PMC10808161 DOI: 10.3389/fped.2023.1275531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Around seventy percent of all childhood cancer patients suffer from severe pain. This pain can arise from various sources, including tumors themselves, pain caused by metastasizing tumor cells or as the outcome of therapy meant to deal with tumors. If managed inadequately, such pain can lead to many hazardous sequelae. However, there are extreme cases when pain does not respond to standard treatment. For such cases, regional anesthesia or nerve blocks are utilized as the utmost pain control measure. Blocks are used to treat pain in patients who no longer respond to conventional opioid-based treatment or whose worsened condition makes it impossible to receive any other therapy. The data regarding the use of regional anesthesia for such cases in the children population is limited. Methods For this review we searched for case reports in Scopus and PubMed from inception to 2023. The descriptive search items included terms related to childhood cancer and the description of each block. The inclusion criteria for review include children (0-18 years old) receiving oncology-related surgical procedures or palliative care. The data collection was limited to solid tumor-related cases only. We analyzed a total of 38 studies that included case reports and one retrospective study. Results and discussion It was concluded that nerve blocks, although rarely performed, are a safe and efficient way of pain control in children with solid tumors. The major settings for block performance are postoperative pain control and palliative care. We observed that block indication and its outcomes depend on unique health circumstances in which they should be performed. Patients with similar diagnoses had differing outcomes while receiving the same block treatment.
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Affiliation(s)
| | - Azhar Zhailauova
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Vitaliy Sazonov
- Department of Surgery, School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Pediatric Anesthesiology and Intensive Care Unit, National Research Center for Maternal and Child Health, University Medical Center, Astana, Kazakhstan
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Karmakar A, Khan MJ, Abdul-Rahman MEF, Shahid U. The Advances and Utility of Artificial Intelligence and Robotics in Regional Anesthesia: An Overview of Recent Developments. Cureus 2023; 15:e44306. [PMID: 37779803 PMCID: PMC10535025 DOI: 10.7759/cureus.44306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
The integration of artificial intelligence (AI) and robotics in regional anesthesia has brought about transformative changes in acute pain management for surgical procedures. This review explores the evolving landscape of AI and robotics applications in regional anesthesia, outlining their potential benefits, challenges, and ethical considerations. AI-driven pain assessment, real-time guidance for needle placement during nerve blocks, and predictive modeling solutions for nerve blocks have the potential to enhance procedural precision and improve patient outcomes. Robotic technology aids in accurate needle insertion, reducing complications and improving pain relief. This review also highlights the ethical and safety considerations surrounding AI implementation, emphasizing data security and professional training. While challenges such as costs and regulatory hurdles exist, ongoing research and clinical trials demonstrate the practical utility of these technologies. In conclusion, AI and robotics have the potential to reshape regional anesthesia practice, ultimately improving patient care and procedural accuracy in pain management.
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Affiliation(s)
- Arunabha Karmakar
- Anesthesiology and Critical Care, Hamad Medical Corporation, Doha, QAT
| | | | | | - Umair Shahid
- Anesthesiology and Critical Care, Hamad Medical Corporation, Doha, QAT
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Sonawane K, Dixit H, Mehta K, Thota N, Gurumoorthi P. "Knowing It Before Blocking It," the ABCD of the Peripheral Nerves: Part C (Prevention of Nerve Injuries). Cureus 2023; 15:e41847. [PMID: 37581128 PMCID: PMC10423097 DOI: 10.7759/cureus.41847] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/16/2023] Open
Abstract
"A clever person solves the problem. A wise person avoids it" (Albert Einstein). There is no convincing evidence that any modality 100% effectively prevents nerve injury. The risk of nerve injury remains the same even with the ultrasound due to limitations in the resolution of images and inter-operator and inter-patient differences. In a nutshell, caution is required when dealing with precious nerves in the perioperative period, either during peripheral nerve blocks (PNBs), patient positioning, or surgery. Identifying pre-existing nerve injury, either due to trauma or an existing neuropathy, and preventing further nerve injury should be an important goal in providing safe regional anesthesia (RA). Multimodal monitoring is key to avoiding multifactorial nerve injuries. The use of triple guidance (ultrasound + peripheral nerve stimulator + injection pressure monitor) during PNBs further improves the safety of RA. The ultrasound helps in real-time visualization of the nerve, needle, and drug spread; the peripheral nerve stimulator helps confirm the target nerves; and the injection pressure monitor helps avoid nerve injury. Such multimodalities can also give the confidence to administer PNB without risk of nerve injury. This article is part of the comprehensive overview of the essential understanding of peripheral nerves before blocking them. It describes various preventive measures to avoid peripheral nerve injuries while administering PNBs. It will help readers understand the importance of prevention in each step to avoid perioperative PNIs.
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Affiliation(s)
- Kartik Sonawane
- Anesthesiology, Ganga Medical Centre and Hospitals, Pvt. Ltd, Coimbatore, IND
| | - Hrudini Dixit
- Anesthesiology, Sir H. N. Reliance Foundation Hospital and Research Centre, Mumbai, IND
| | - Kaveri Mehta
- Anesthesia and Critical Care, Corniche Hospital, Abu Dhabi, ARE
| | - Navya Thota
- Anesthesiology, Ganga Medical Centre and Hospitals, Pvt. Ltd, Coimbatore, IND
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Kornilov E, Gehlen L, Yacobi D, Soehle M, Kowark A, Thudium M. Pupillary Pain Index Predicts Postoperative Pain but Not the Effect of Peripheral Regional Anaesthesia in Patients Undergoing Total Hip or Total Knee Arthroplasty: An Observational Study. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050826. [PMID: 37241058 DOI: 10.3390/medicina59050826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: The pupillary pain index (PPI) allows the evaluation of intraoperative nociception by measuring pupillary reaction after a localized electrical stimulus. It was the objective of this observational cohort study to investigate the pupillary pain index (PPI) as a method to evaluate the fascia iliaca block (FIB) or adductor canal block (ACB) sensory areas during general anaesthesia in orthopaedic patients with lower-extremity joint replacement surgery. Materials and Methods: Orthopaedic patients undergoing hip or knee arthroplasty were included. After anaesthesia induction, patients received an ultrasound-guided single-shot FIB or ACB with 30 mL and 20 mL of 0.375% ropivacaine, respectively. Anaesthesia was maintained with isoflurane or propofol/remifentanil. The first PPI measurements were performed after anaesthesia induction and before block insertion, the second at the end of surgery. Pupillometry scores were evaluated in the area of the femoral or saphenous nerve (target) and C3 dermatome (control). Primary outcomes were differences between PPIs before and after peripheral block insertion as well as the relationship between PPIs and postoperative pain scores; secondary outcomes were the relationship between PPIs and opioid requirements after surgery. Results: PPI decreased significantly from the first to the second measurement (4.17 ± 2.7 vs. 1.6 ± 1.2, p < 0.001 for target; 4.46 ± 2.7 vs. 2.17 ± 2.1, p < 0.001 for control). Control and target measurements did not show significant differences. A linear regression analysis showed that early postoperative pain scores could be predicted with intraoperative piritramide with improved prediction after adding PPI scores, PCA opioids and surgery type. Forty-eight-hour pain scores at rest and in movement were correlated with intraoperative piritramide and control PPI after the PNB in movement and with second-postoperative-day opioids and target PPI scores before block insertion, respectively. Conclusions: While the effect of an FIB and ACB could not be shown with PPI postoperative pain scores due to a large effect of opioids, perioperative PPI was shown to be associated with postoperative pain. These results suggest that preoperative PPI may be used to predict postoperative pain.
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Affiliation(s)
- Evgeniya Kornilov
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
- Department of Anaesthesia, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Street, Petach Tikva 4941492, Israel
- Department of Neurobiology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 7610001, Israel
| | - Lena Gehlen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Dana Yacobi
- Department of Neurobiology, Weizmann Institute of Science, 234 Herzl Street, Rehovot 7610001, Israel
| | - Martin Soehle
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Ana Kowark
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - Marcus Thudium
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany
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Bottomley T, Gadsden J, West S. The failed peripheral nerve block. BJA Educ 2023; 23:92-100. [PMID: 36844443 PMCID: PMC9947978 DOI: 10.1016/j.bjae.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- T. Bottomley
- University College London NHS Foundation Trust, London, UK
| | - J. Gadsden
- Duke University Medical Centre, Durham, NC, USA
| | - S. West
- University College London NHS Foundation Trust, London, UK
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Bowness JS, Macfarlane AJ, Burckett-St Laurent D, Harris C, Margetts S, Morecroft M, Phillips D, Rees T, Sleep N, Vasalauskaite A, West S, Noble JA, Higham H. Evaluation of the impact of assistive artificial intelligence on ultrasound scanning for regional anaesthesia. Br J Anaesth 2023; 130:226-233. [PMID: 36088136 PMCID: PMC9900732 DOI: 10.1016/j.bja.2022.07.049] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/26/2022] [Accepted: 07/14/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Ultrasound-guided regional anaesthesia relies on the visualisation of key landmark, target, and safety structures on ultrasound. However, this can be challenging, particularly for inexperienced practitioners. Artificial intelligence (AI) is increasingly being applied to medical image interpretation, including ultrasound. In this exploratory study, we evaluated ultrasound scanning performance by non-experts in ultrasound-guided regional anaesthesia, with and without the use of an assistive AI device. METHODS Twenty-one anaesthetists, all non-experts in ultrasound-guided regional anaesthesia, underwent a standardised teaching session in ultrasound scanning for six peripheral nerve blocks. All then performed a scan for each block; half of the scans were performed with AI assistance and half without. Experts assessed acquisition of the correct block view and correct identification of sono-anatomical structures on each view. Participants reported scan confidence, experts provided a global rating score of scan performance, and scans were timed. RESULTS Experts assessed 126 ultrasound scans. Participants acquired the correct block view in 56/62 (90.3%) scans with the device compared with 47/62 (75.1%) without (P=0.031, two data points lost). Correct identification of sono-anatomical structures on the view was 188/212 (88.8%) with the device compared with 161/208 (77.4%) without (P=0.002). There was no significant overall difference in participant confidence, expert global performance score, or scan time. CONCLUSIONS Use of an assistive AI device was associated with improved ultrasound image acquisition and interpretation. Such technology holds potential to augment performance of ultrasound scanning for regional anaesthesia by non-experts, potentially expanding patient access to these techniques. CLINICAL TRIAL REGISTRATION NCT05156099.
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Affiliation(s)
- James S. Bowness
- Oxford Simulation, Teaching and Research Centre, University of Oxford, Oxford, UK,Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK,Corresponding author.
| | - Alan J.R. Macfarlane
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK,School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
| | | | - Catherine Harris
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | | | | | - David Phillips
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - Tom Rees
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | | | | | - Simeon West
- Department of Anaesthesia, University College London, London, UK
| | - J. Alison Noble
- Institute of Biomedical Engineering, University of Oxford, UK
| | - Helen Higham
- Oxford Simulation, Teaching and Research Centre, University of Oxford, Oxford, UK,Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Mufarrih SH, Qureshi NQ, Yunus RA, Katsiampoura A, Quraishi I, Sharkey A, Mahmood F, Matyal R. A Systematic Review and Meta-analysis of General versus Regional Anesthesia for Lower Extremity Amputation. J Vasc Surg 2022; 77:1542-1552.e9. [PMID: 36243265 DOI: 10.1016/j.jvs.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Postoperative morbidity in patients undergoing lower extremity amputation (LEA) has remained high. Studies investigating the influence of the anesthetic modality on the postoperative outcomes have yielded conflicting results. The aim of our study was to assess the effects of regional anesthesia vs general anesthesia on postoperative complications for patients undergoing LEA. METHODS We systematically searched PubMed, Embase, MEDLINE, Web of Science, and Google Scholar from 1990 to 2022 for studies investigating the effect of the anesthetic modality on the postoperative outcomes after LEA. Regional anesthesia (RA) included neuraxial anesthesia and peripheral nerve blocks. The outcomes included 30-day mortality, respiratory failure (unplanned postoperative intubation, failure to wean, mechanical ventilation >24 hours), surgical site infection, cardiac complications, urinary tract infection, renal failure, sepsis, venous thrombosis, pneumonia, and myocardial infarction. RESULTS Of the 25 studies identified, we included 10 retrospective observational studies with 81,736 patients, of whom 69,754 (85.3%) had received general anesthesia (GA) and 11,980 (14.7%) had received RA. In the GA group, 50,468 patients were men (63.8%), and in the RA group, 7813 patients were men (62.3%). The results of the meta-analyses revealed that GA was associated with a higher rate of respiratory failure (odds ratio, 1.38; 95% confidence interval, 1.06-1.80; P = .02) and sepsis (odds ratio, 1.21; 95% confidence interval, 1.11-1.33; P < .0001) compared with RA. No differences were found in postoperative 30-day mortality, surgical site infection, cardiac complications, urinary tract infection, renal failure, venous thrombosis, pneumonia, and myocardial infarction between the GA and RA groups. CONCLUSIONS The results of our meta-analysis have shown that GA could be associated with a higher rate of respiratory failure and sepsis compared with RA for LEA.
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12
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Ashken T, Bowness J, Macfarlane AJR, Turbitt L, Bellew B, Bedforth N, Burckett-St Laurent D, Delbos A, El-Boghdadly K, Elkassabany NM, Ferry J, Fox B, French JLH, Grant C, Gupta A, Gupta RK, Gürkan Y, Haslam N, Higham H, Hogg RMG, Johnston DF, Kearns RJ, Lobo C, McKinlay S, Mariano ER, Memtsoudis S, Merjavy P, Narayanan M, Noble JA, Phillips D, Rosenblatt M, Sadler A, Sebastian MP, Schwenk ES, Taylor A, Thottungal A, Valdés-Vilches LF, Volk T, West S, Wolmarans M, Womack J, Pawa A. Recommendations for anatomical structures to identify on ultrasound for the performance of intermediate and advanced blocks in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 2022; 47:762-772. [DOI: 10.1136/rapm-2022-103738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/17/2022] [Indexed: 11/03/2022]
Abstract
Recent recommendations describe a set of core anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia (UGRA). This project aimed to generate consensus recommendations for core structures to identify during the performance of intermediate and advanced blocks. An initial longlist of structures was refined by an international panel of key opinion leaders in UGRA over a three-round Delphi process. All rounds were conducted virtually and anonymously. Blocks were considered twice in each round: for “orientation scanning” (the dynamic process of acquiring the final view) and for “block view” (which visualizes the block site and is maintained for needle insertion/injection). A “strong recommendation” was made if ≥75% of participants rated any structure as “definitely include” in any round. A “weak recommendation” was made if >50% of participants rated it as “definitely include” or “probably include” for all rounds, but the criterion for strong recommendation was never met. Structures which did not meet either criterion were excluded. Forty-one participants were invited and 40 accepted; 38 completed all three rounds. Participants considered the ultrasound scanning for 19 peripheral nerve blocks across all three rounds. Two hundred and seventy-four structures were reviewed for both orientation scanning and block view; a “strong recommendation” was made for 60 structures on orientation scanning and 44 on the block view. A “weak recommendation” was made for 107 and 62 structures, respectively. These recommendations are intended to help standardize teaching and research in UGRA and support widespread and consistent practice.
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Artificial Intelligence: Innovation to Assist in the Identification of Sono-anatomy for Ultrasound-Guided Regional Anaesthesia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1356:117-140. [PMID: 35146620 DOI: 10.1007/978-3-030-87779-8_6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Ultrasound-guided regional anaesthesia (UGRA) involves the targeted deposition of local anaesthesia to inhibit the function of peripheral nerves. Ultrasound allows the visualisation of nerves and the surrounding structures, to guide needle insertion to a perineural or fascial plane end point for injection. However, it is challenging to develop the necessary skills to acquire and interpret optimal ultrasound images. Sound anatomical knowledge is required and human image analysis is fallible, limited by heuristic behaviours and fatigue, while its subjectivity leads to varied interpretation even amongst experts. Therefore, to maximise the potential benefit of ultrasound guidance, innovation in sono-anatomical identification is required.Artificial intelligence (AI) is rapidly infiltrating many aspects of everyday life. Advances related to medicine have been slower, in part because of the regulatory approval process needing to thoroughly evaluate the risk-benefit ratio of new devices. One area of AI to show significant promise is computer vision (a branch of AI dealing with how computers interpret the visual world), which is particularly relevant to medical image interpretation. AI includes the subfields of machine learning and deep learning, techniques used to interpret or label images. Deep learning systems may hold potential to support ultrasound image interpretation in UGRA but must be trained and validated on data prior to clinical use.Review of the current UGRA literature compares the success and generalisability of deep learning and non-deep learning approaches to image segmentation and explains how computers are able to track structures such as nerves through image frames. We conclude this review with a case study from industry (ScanNav Anatomy Peripheral Nerve Block; Intelligent Ultrasound Limited). This includes a more detailed discussion of the AI approach involved in this system and reviews current evidence of the system performance.The authors discuss how this technology may be best used to assist anaesthetists and what effects this may have on the future of learning and practice of UGRA. Finally, we discuss possible avenues for AI within UGRA and the associated implications.
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14
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Bowness JS, Pawa A, Turbitt L, Bellew B, Bedforth N, Burckett-St Laurent D, Delbos A, Elkassabany N, Ferry J, Fox B, French JLH, Grant C, Gupta A, Harrop-Griffiths W, Haslam N, Higham H, Hogg R, Johnston DF, Kearns RJ, Kopp S, Lobo C, McKinlay S, Memtsoudis S, Merjavy P, Moka E, Narayanan M, Narouze S, Noble JA, Phillips D, Rosenblatt M, Sadler A, Sebastian MP, Taylor A, Thottungal A, Valdés-Vilches LF, Volk T, West S, Wolmarans M, Womack J, Macfarlane AJR. International consensus on anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 2021; 47:106-112. [PMID: 34552005 DOI: 10.1136/rapm-2021-103004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought through a modified Delphi process. A long-list of anatomical structures was refined through serial review by key opinion leaders in UGRA. All rounds were conducted remotely and anonymously to facilitate equal contribution of each participant. Blocks were considered twice in each round: for "orientation scanning" (the dynamic process of acquiring the final view) and for the "block view" (which visualizes the block site and is maintained for needle insertion/injection). Strong recommendations for inclusion were made if ≥75% of participants rated a structure as "definitely include" in any round. Weak recommendations were made if >50% of participants rated a structure as "definitely include" or "probably include" for all rounds (but the criterion for "strong recommendation" was never met). Thirty-six participants (94.7%) completed all rounds. 128 structures were reviewed; a "strong recommendation" is made for 35 structures on orientation scanning and 28 for the block view. A "weak recommendation" is made for 36 and 20 structures, respectively. This study provides recommendations on the core (minimum) set of anatomical structures to identify during ultrasound scanning for seven basic blocks in UGRA. They are intended to support consistent practice, empower non-experts using basic UGRA techniques, and standardize teaching and research.
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Affiliation(s)
- James Simeon Bowness
- OxSTaR, Oxford University, Oxford, UK .,Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
| | - Amit Pawa
- Department of Anaesthesia, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Boyne Bellew
- Department of Surgery & Cancer, Imperial College London, London, UK.,Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - Nigel Bedforth
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Alain Delbos
- Department of Anesthesia, Clinique Médipole Garonne, Toulouse, France
| | - Nabil Elkassabany
- Department of Anesthesiology & Intensive Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jenny Ferry
- Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
| | - Ben Fox
- Department of Anaesthesia, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, Norfolk, UK
| | - James L H French
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Calum Grant
- Department of Anaesthesia, NHS Tayside, Dundee, UK
| | - Ashwani Gupta
- Department of Anaesthesia, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | | | - Nat Haslam
- Department of Anaesthesia, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Helen Higham
- OxSTaR, Oxford University, Oxford, UK.,Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - David F Johnston
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Rachel Joyce Kearns
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.,Department of Anaesthesia, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sandra Kopp
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Clara Lobo
- Anestesiologista, Hospital das Forças Armadas Polo do Porto, Porto, Portugal
| | - Sonya McKinlay
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.,Department of Anaesthesia, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stavros Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Specialist Surgery, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Peter Merjavy
- Department of Anaesthesia, Craigavon Area Hospital, Portadown, UK
| | - Eleni Moka
- Department of Anaesthesiology, Hellenic Healthcare Group (HHG), Heraklion Crete, Greece
| | - Madan Narayanan
- Department of Anaesthesia, Frimley Park Hospital, Frimley, UK
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | | | - David Phillips
- Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
| | | | - Amy Sadler
- Department of Anaesthesia, NHS Tayside, Dundee, UK
| | - Maria Paz Sebastian
- Department of Anaesthetics, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - Athmaja Thottungal
- Department of Anaesthesia & Pain Management, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | | | - Thomas Volk
- Department of Anaesthesiology, Critical Care & Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Simeon West
- Department of Anaesthetics, University College London, London, UK
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Jonathan Womack
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Alan James Robert Macfarlane
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.,Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
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Bowness J, Varsou O, Turbitt L, Burkett-St Laurent D. Identifying anatomical structures on ultrasound: assistive artificial intelligence in ultrasound-guided regional anesthesia. Clin Anat 2021; 34:802-809. [PMID: 33904628 DOI: 10.1002/ca.23742] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 12/29/2022]
Abstract
Ultrasound-guided regional anesthesia involves visualizing sono-anatomy to guide needle insertion and the perineural injection of local anesthetic. Anatomical knowledge and recognition of anatomical structures on ultrasound are known to be imperfect amongst anesthesiologists. This investigation evaluates the performance of an assistive artificial intelligence (AI) system in aiding the identification of anatomical structures on ultrasound. Three independent experts in regional anesthesia reviewed 40 ultrasound scans of seven body regions. Unmodified ultrasound videos were presented side-by-side with AI-highlighted ultrasound videos. Experts rated the overall system performance, ascertained whether highlighting helped identify specific anatomical structures, and provided opinion on whether it would help confirm the correct ultrasound view to a less experienced practitioner. Two hundred and seventy-five assessments were performed (five videos contained inadequate views); mean highlighting scores ranged from 7.87 to 8.69 (out of 10). The Kruskal-Wallis H-test showed a statistically significant difference in the overall performance rating (χ2 [6] = 36.719, asymptotic p < 0.001); regions containing a prominent vascular landmark ranked most highly. AI-highlighting was helpful in identifying specific anatomical structures in 1330/1334 cases (99.7%) and for confirming the correct ultrasound view in 273/275 scans (99.3%). These data demonstrate the clinical utility of an assistive AI system in aiding the identification of anatomical structures on ultrasound during ultrasound-guided regional anesthesia. Whilst further evaluation must follow, such technology may present an opportunity to enhance clinical practice and energize the important field of clinical anatomy amongst clinicians.
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Affiliation(s)
- James Bowness
- Oxford Simulation, Teaching and Research Centre, University of Oxford, Oxford, UK.,Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK
| | - Ourania Varsou
- Anatomy Facility, School of Life Sciences, University of Glasgow, Glasgow, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
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Tovar-Gutiérrez A, Camelo-Rincón JE, Vásquez-Gómez ÓI, Cadavid-Puentes AM. Continuous erector spinae plane block at lumbar level for relief of severe pain due to hip fracture: case series. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2021. [DOI: 10.5554/22562087.e962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Hip fracture pain is frequently acute and disabling and increases perioperative complications in the patient; hence it requires a multimodal analgesia approach. This case series describes the continuous erector spinae plane block at the lumbar level for hip fracture analgesia.
Methods: A search was conducted of patients with hip fracture referred to the pain service of Hospital Universitario San Vicente Fundación (HUSVF) from August 2019 to March 2020, who had undergone continuous erector spinae plane block as part of their analgesic regimen.
Results: A total of 6 patients, 4 females and 2 males with an average age of 75 years were identified. A reduction in pain intensity from acute to mild or absent was observed in every case, up to 24 hours after the initial injection. 66 % experienced a relapse of severe pain after 24 hours and 2 patients the catheter functionality failed after 24 hours. One patient underwent dermatome pinprick assessment.
Conclusions: The continuous erector spinae plane block with a single injection provided analgesic efficacy similar to other single injection peripheral blocks, although continuous analgesia for more than 24 hours was not achieved. Some variations in the block technique described may improve the analgesic effectiveness in patients with hip fracture pain.
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Ifelayo OI, Oyemade KA, Tawfic SS, Jeeji AK, Ekstein SF, Smoot WA, Voelkel JE, Laughlin MJ, Lohse CM, Kummer T, Bellamkonda VR. Increased body mass index does not impact the imaging quality of focused assessment with sonography in trauma. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:452-456. [PMID: 32557626 DOI: 10.1002/jcu.22884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Many clinicians believe that a patient's body mass index (BMI) affects the likelihood of obtaining high quality ultrasound images. OBJECTIVES To assess the hypothesis that increased BMI is associated with worsening focused assessment with sonography in trauma (FAST) image quality. METHODS We conducted a retrospective single-center study of FAST examinations performed in a large academic emergency department (ED) with fellowship-trained emergency ultrasonography faculty performing quality assurance review. RESULTS Mean (SD) BMI was 28.0 (6.6) among the 302 included studies. The overall quality rating tended to decrease as BMI increased but did not achieve statistical significance in a univariable setting (P = .06) or after adjustment for age and sex (P = .06). Operators perception of image adequacy was largely unaffected by BMI, with the exception of the pericardial view. CONCLUSION This study did not identify a statistically significant difference in FAST quality with increased BMI. This result may help assuage clinician concerns about ultrasonography for patients in the ED.
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Affiliation(s)
- Oluwatomilona I Ifelayo
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Kafayat A Oyemade
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Sarah S Tawfic
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Archana K Jeeji
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Samuel F Ekstein
- Mayo Clinic Alix School of Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - William A Smoot
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Jacob E Voelkel
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Michael J Laughlin
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Christine M Lohse
- Department of Biostatistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Tobias Kummer
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Venkatesh R Bellamkonda
- Department of Emergency Medicine, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Romano M, Portela DA, Otero PE, Thomson A. Mirroring artefact during postoperative transversus abdominis plane (TAP) block in two dogs. Vet Anaesth Analg 2020; 47:727-728. [DOI: 10.1016/j.vaa.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/13/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022]
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