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Bowness JS, Liu X, Keane PA. Leading in the development, standardised evaluation, and adoption of artificial intelligence in clinical practice: regional anaesthesia as an example. Br J Anaesth 2024; 132:1016-1021. [PMID: 38302346 DOI: 10.1016/j.bja.2023.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/19/2023] [Accepted: 12/27/2023] [Indexed: 02/03/2024] Open
Abstract
A recent study by Suissa and colleagues explored the clinical relevance of a medical image segmentation metric (Dice metric) commonly used in the field of artificial intelligence (AI). They showed that pixel-wise agreement for physician identification of structures on ultrasound images is variable, and a relatively low Dice metric (0.34) correlated to a substantial agreement on subjective clinical assessment. We highlight the need to bring structure and clinical perspective to the evaluation of medical AI, which clinicians are best placed to direct.
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Affiliation(s)
- James S Bowness
- Nuffield Department of Clinical Anaesthesia, University of Oxford, Oxford, UK; Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, UK.
| | - Xiaoxuan Liu
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Pearse A Keane
- Institute of Ophthalmology, Faculty of Brain Sciences, University College London, London, UK; NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK
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Ferry J, Lewis O, Lloyd J, El-Boghdadly K, Kearns R, Albrecht E, Altermatt F, Ashokka B, Ayad AE, Aziz ES, Aziz L, Jagannathan B, Bouarroudj N, Chin KJ, Delbos A, de Gracia A, Ip VHY, Kwofie K, Layera S, Lobo CA, Mohammed M, Moka E, Moreno M, Morgan B, Polela A, Rahimzadeh P, Tangwiwat S, Uppal V, Vaz Perez M, Volk T, Wong PBY, Bowness JS, Macfarlane AJR. Research priorities in regional anaesthesia: an international Delphi study. Br J Anaesth 2024; 132:1041-1048. [PMID: 38448274 PMCID: PMC11103078 DOI: 10.1016/j.bja.2024.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. METHODS We invited members of specialist regional anaesthesia societies from six continents to propose research questions that they felt were unanswered. These were consolidated into representative indicative questions, and a literature review was undertaken to determine if any indicative questions were already answered by published work. Unanswered indicative questions entered a three-round modified Delphi process, whereby 29 experts in regional anaesthesia (representing all participating specialist societies) rated each indicative question for inclusion on a final high priority shortlist. If ≥75% of participants rated an indicative question as 'definitely' include in any round, it was accepted. Indicative questions rated as 'definitely' or 'probably' by <50% of participants in any round were excluded. Retained indicative questions were further ranked based on the rating score in the final Delphi round. The final research priorities were ratified by the Delphi expert group. RESULTS There were 1318 responses from 516 people in the initial survey, from which 71 indicative questions were formed, of which 68 entered the modified Delphi process. Eleven 'highest priority' research questions were short listed, covering themes of pain management; training and assessment; clinical practice and efficacy; technology and equipment. CONCLUSIONS We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas.
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Affiliation(s)
- Jenny Ferry
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - Owen Lewis
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - James Lloyd
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - Kariem El-Boghdadly
- Department of Anaesthesia & Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Rachel Kearns
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Eric Albrecht
- University Hospital of Lausanne, Lausanne, Switzerland; Department of Anaesthesia, University of Lausanne, Lausanne, Switzerland
| | - Fernando Altermatt
- Department of Anesthesiology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Amany E Ayad
- Department of Anesthesia, ICU and Pain, Cairo University, Cairo, Egypt
| | - Ezzat S Aziz
- Department of Anesthesia, ICU and Pain, Cairo University, Cairo, Egypt
| | - Lutful Aziz
- Department of Anaesthesia and Pain Medicine, Evercare Hospital, Dhaka, Bangladesh
| | | | | | - Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada
| | - Alain Delbos
- Department of Anesthesia, Medipole Garonne, Toulouse, France
| | - Alex de Gracia
- Hospital Rafael Estevez, Caja de Seguro Social, Aguadulce, Panama
| | - Vivian H Y Ip
- Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Kwesi Kwofie
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sebastian Layera
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | | | | | - Eleni Moka
- Creta InterClinic Hospital, Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | - Milena Moreno
- Department of Anaesthesiology, Pontifical Xavierian University, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Columbia
| | - Bethan Morgan
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Arthur Polela
- Department of Anaesthesia and Critical Care, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | - Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vishal Uppal
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Marcelo Vaz Perez
- Departament of Anesthesiology and Pain Therapy of Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Centre, Homburg, Germany; Faculty of Medicine, Saarland University, Homburg, Germany
| | - Patrick B Y Wong
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - James S Bowness
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK; Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.
| | - Alan J R Macfarlane
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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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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Shevlin SP, Turbitt L, Burckett-St Laurent D, Macfarlane AJ, West S, Bowness JS. Augmented Reality in Ultrasound-Guided Regional Anaesthesia: An Exploratory Study on Models With Potential Implications for Training. Cureus 2023; 15:e42346. [PMID: 37621802 PMCID: PMC10445048 DOI: 10.7759/cureus.42346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Needle tip visualisation is a key skill required for the safe practice of ultrasound-guided regional anaesthesia (UGRA). This exploratory study assesses the utility of a novel augmented reality device, NeedleTrainer™, to differentiate between anaesthetists with varying levels of UGRA experience in a simulated environment. Methods Four groups of five participants were recruited (n = 20): novice, early career, experienced anaesthetists, and UGRA experts. Each participant performed three simulated UGRA blocks using NeedleTrainer™ on healthy volunteers (n = 60). The primary aim was to determine whether there was a difference in needle tip visibility, as calculated by the device, between groups of anaesthetists with differing levels of UGRA experience. Secondary aims included the assessment of simulated block conduct by an expert assessor and subjective participant self-assessment. Results The percentage of time the simulated needle tip was maintained in view was higher in the UGRA expert group (57.1%) versus the other three groups (novice 41.8%, early career 44.5%, and experienced anaesthetists 43.6%), but did not reach statistical significance (p = 0.05). An expert assessor was able to differentiate between participants of different UGRA experience when assessing needle tip visibility (novice 3.3 out of 10, early career 5.1, experienced anaesthetists 5.9, UGRA expert group 8.7; p < 0.01) and final needle tip placement (novice 4.2 out of 10, early career 5.6, experienced anaesthetists 6.8, UGRA expert group 8.9; p < 0.01). Subjective self-assessment by participants did not differentiate UGRA experience when assessing needle tip visibility (p = 0.07) or final needle tip placement (p = 0.07). Discussion An expert assessor was able to differentiate between participants with different levels of UGRA experience in this simulated environment. Objective NeedleTrainer™ and subjective participant assessments did not reach statistical significance. The findings are novel as simulated needling using live human subjects has not been assessed before, and no previous studies have attempted to objectively quantify needle tip visibility during simulated UGRA techniques. Future research should include larger sample sizes to further assess the potential use of such technology.
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Affiliation(s)
- Sean P Shevlin
- Anaesthesia, Belfast Health and Social Care Trust, Belfast, GBR
| | - Lloyd Turbitt
- Anaesthesia, Belfast Health and Social Care Trust, Belfast, GBR
| | | | | | - Simeon West
- Anaesthesia, University College London Hospital, London, GBR
| | - James S Bowness
- Anaesthesia, Aneurin Bevan University Health Board, Newport, GBR
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Li R. Application of Ultrasound-Guided Cervical Plexus Block in Type I Thyroid Cartilage Laryngoplasty and Vocal Cord Medialization Surgery. EAR, NOSE & THROAT JOURNAL 2022:1455613221115114. [PMID: 35861187 DOI: 10.1177/01455613221115114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Under the background that cervical plexus block (CPB) is often adopted for type I thyroid cartilage laryngoplasty (TCL) and vocal cord medialization (VCM), the present study sought to investigate whether ultrasound-guided CPB (USCPB) could improve the efficiency of type I TCL and VCM. METHODS Patients with TCL were enrolled and subjected to deep and superficial USCPBs. Intravenous dexmedetomidine pumping was used to assist the painless sedation and ensure the patients to be awake for phonation during surgery. Blood pressure, electrocardiogram, heart rate (HR), and blood oxygen saturation (SpO2) of patients were recorded. The complications, like local anesthetic toxicity and total spinal anesthesia, were monitored. RESULTS All patients underwent CPB without infiltration anesthesia and complication. The use of Sufentanil at the dose of 5-10 μg was reported in 2 of 15 patients. No Horner syndrome was discovered in patients after anesthesia, and total intravenous anesthesia with intravenous pumping of dexmedetomidine was effective. During surgery, HR, diastolic blood pressure and mean blood pressure were barely changed, but systolic blood pressure was decreased. CONCLUSION Ultrasound-guided CPB with the intravenous dexmedetomidine pumping is a safe anesthesia method for patients during TCL.
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Affiliation(s)
- Ronggang Li
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
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Zhang W, Yu H, Duan Z, Yu T, Li X. Anesthesia depth evaluation algorithm based on permutation and combination entropy. Neural Comput Appl 2022. [DOI: 10.1007/s00521-021-06030-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen L, Zhu LJ, Ding XH, Zhu JM, Zhang ZF, Ni Y. Identification of the popliteal sciatic nerve through the above-knee lateral approach provides superior echogenicity and ultrasound visibility: a patient volunteer trial. Minerva Anestesiol 2022; 88:660-667. [PMID: 35416464 DOI: 10.23736/s0375-9393.22.16264-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Distinguishing light-echoed nerves from surrounding structures is challenging but may be important in nerve block administration. We evaluated the effect of patient characteristics on the echogenicity or visibility of the popliteal sciatic nerve (PSN). METHODS This study included adult patients who presented to the operating room as volunteers. The primary outcome was the success rate of nerve identification by ultrasound using different PSN access paths. The secondary outcome included the PSN visibility score (VIS), scan time, and PSN depth. Logistic regression analysis was used to identify factors associated with the PSN identification success rate. The body mass index (BMI) proximal-based cut-off was used to compare the PSN identification success rate through different access paths. RESULTS The PSN was successfully identified in 89.7% of the volunteers. The access paths (P < 0.01) and BMI (P = 0.01) were identified as independent predictors of successful PSN identification. A higher PSN identification success rate (P = 0.01), a higher VIS (P < 0.01), a more superficial PSN depth (P < 0.01), and a shorter scan time (P < 0.01) were observed in the above-knee lateral approach. Among volunteers with BMI ≥ 26.77 kg/m2, the PSN identification success rate through the above-knee lateral approach was significantly higher (P < 0.01), and PSN depth was shallower (P < 0.01) than through the medial approach. CONCLUSIONS The ultrasound-guided above-knee lateral approach for PSN block improved the PSN identification success rate, ensured a more superficial nerve location, and provided a clearer image.
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Affiliation(s)
- Liang Chen
- Department of Neurology, the Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lin-Jia Zhu
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xia-Hao Ding
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jing-Ming Zhu
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zhen-Feng Zhang
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yan Ni
- Department of Anesthesiology and Perioperative Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, China -
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Dufour E, Jaziri S, Novillo MA, Aubert L, Chambon A, Kutz R, Vallée A, Fischler M. A randomized trial to determine the minimum effective lidocaine volume for median nerve block using hydrodissection. Sci Rep 2022; 12:52. [PMID: 34996918 PMCID: PMC8742045 DOI: 10.1038/s41598-021-03660-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 11/19/2021] [Indexed: 11/09/2022] Open
Abstract
Ultrasound-guided hydrodissection with 5% dextrose in water (DW5) creates a peri-nervous compartment, separating the nerve from the neighboring anatomical structures. The aim of this randomized study was to determine the minimum volume of lidocaine 2% with epinephrine 1:200,000 required when using this technique to achieve an effective median nerve block at the elbow in 95% of patients (MEAV95). Fifty-two patients scheduled for elective hand surgery received an ultrasound-guided circumferential perineural injection of 4 ml DW5 and an injection of local anesthetic (LA) following a biased coin up-and-down sequential allocation method. A successful block was defined as a light touch completely suppressed on the two distal phalanges of the index finger within a 30-min evaluation period. The MEAV95 of lidocaine 2% with epinephrine was 4 ml [IQR 3.5–4.0]. Successful median nerve block was obtained in 38 cases (82.6%) with median onset time of 20.0 [10.0–21.2] minutes (95% CI 15–20). The analgesia duration was 248 [208–286] minutes (95% CI 222–276). Using an ultrasound-guided hydrodissection technique with DW5, the MEAV95 to block the median nerve at the elbow with 2% lidocaine with epinephrine was 4 ml [IQR 3.5–4.0]. This volume is close to that usually recommended in clinical practice. Trial registration clinicaltrials.gov. NCT02438657, Date of registration: May 8, 2015.
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Affiliation(s)
- Eric Dufour
- Department of Anesthesiology, Centre Hospitalier de la Côte Basque, 64109, Bayonne, France
| | - Souhail Jaziri
- Department of Anesthesiology, Hopital Privé de l'Ouest Parisien, 78190, Trappes, France
| | - Marie Alice Novillo
- Department of Anesthesiology, Hopital Privé de l'Ouest Parisien, 78190, Trappes, France
| | - Lila Aubert
- Department of Anesthesiology, Centre Hospitalier de la Côte Basque, 64109, Bayonne, France
| | - Anne Chambon
- Department of Pharmacy, Centre Hospitalier de la Côte Basque, 64109, Bayonne, France
| | - Rainer Kutz
- Department of Anesthesiology, Centre Hospitalier de la Côte Basque, 64109, Bayonne, France
| | - Alexandre Vallée
- Department of Clinical Research and Innovation, Hôpital Foch, 92150, Suresnes, France
| | - Marc Fischler
- Department of Anesthesiology, Hôpital Foch, 40 rue Worth, 92150, Suresnes, France.
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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: 6] [Impact Index Per Article: 3.0] [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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Cao Z, Zhang K, Hu L, Pan J. Application of ultrasound guidance in the oral and maxillofacial nerve block. PeerJ 2021; 9:e12543. [PMID: 34900442 PMCID: PMC8628623 DOI: 10.7717/peerj.12543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/04/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction Nerve block technology is widely used in clinical practice for pain management. Conventional nerve localization methods, which only rely on palpation to identify anatomical landmarks, require experienced surgeons and can be risky. Visualization technologies like ultrasound guidance can help prevent complications by helping surgeons locate anatomical structures in the surgical area and by guiding the operation using different kinds of images. There are several important and complex anatomical structures in the oral and maxillofacial regions. The current article reviews the application of ultrasound guidance in oral and maxillofacial nerve blocks. Methods We searched the literature on the use of ultrasound guidance for the main nerve block techniques in the oral and maxillofacial regions using both PubMed and MEDLINE and summarized the findings. Results and Discussion A review of the literature showed that ultrasound guidance improves the safety and effectiveness of several kinds of puncture procedures, including nerve blocks. There are two approaches to blocking the mandibular nerve: intraoral and extraoral. This review found that the role of ultrasound guidance is more important in the extraoral approach. There are also two approaches to the blocking of the maxillary nerve and the trigeminal ganglion under ultrasound guidance: the superazygomatic approach and the infrazygomatic approach. The infrazygomatic approach can be further divided into the anterior approach and the posterior approach. It is generally believed that the anterior approach is safer and more effective. This review found that the effectiveness and safety of most oral and maxillofacial nerve block operations can be improved through the use of ultrasound guidance.
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Affiliation(s)
- Zhiwei Cao
- Department of Oral Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Kun Zhang
- Department of Oral Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Liru Hu
- Department of Oral Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
| | - Jian Pan
- Department of Oral Surgery, State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China Hospital of Stomatology, Sichuan University, Chengdu, Sichuan, China
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Hussain N, Costache I, Kumar N, Essandoh M, Weaver T, Wong P, Tierney S, Rose P, McCartney CJL, Abdallah FW. Is Supraclavicular Block as Good as Interscalene Block for Acute Pain Control Following Shoulder Surgery? A Systematic Review and Meta-analysis. Anesth Analg 2020; 130:1304-1319. [PMID: 32102013 DOI: 10.1213/ane.0000000000004692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Interscalene block (ISB) is the acute pain management technique of choice for shoulder surgery, but its undesirable respiratory side effects have prompted seeking alternatives. Supraclavicular block (SCB) is proposed as an ISB alternative, but evidence of comparative analgesic and respiratory-sparing effects is inconsistent. We compared the analgesic and respiratory effects of SCB and ISB for shoulder surgery. METHODS Trials comparing ISB to SCB for shoulder surgery were sought. We decided a priori that SCB would be an acceptable alternative if it were noninferior for (1) postoperative 24-hour cumulative oral morphine equivalent consumption (primary outcome, noninferiority margin Δ = -25 mg) and (2) postoperative pain (secondary outcome, noninferiority margin Δ = 4.0 cm·hour); and superior for (3) postblock respiratory dysfunction (primary outcome). Opioid-related side effects and block-related complications were also evaluated. RESULTS Fifteen studies (1065 patients) were analyzed. In single-injection blocks, SCB was noninferior to ISB for 24-hour morphine consumption (mean difference for SCB-ISB, MD [95% confidence interval {CI}] = -3.11 mg [-9.42 to 3.19], Δ = -25 mg); it was also noninferior for 24-hour pain scores (MD = 0.78 cm·hour [0.07-1.49], Δ = 4.0 cm·hour); and decreased the odds of respiratory dysfunction (odds ratio [OR] [95% CI] = 0.08 [0.01-0.68]). Similarly, in continuous blocks, SCB was noninferior to ISB for 24-hour morphine consumption (MD = 0.46 mg [-6.08 to 5.15], Δ = -25 mg), and decreased the odds of respiratory dysfunction (OR = 0.22 [0.08-0.57]). SCB also decreased odds of minor block-related complications (OR = 0.36 [0.20-0.68] and OR = 0.25 [0.15-0.41] for single-injection and continuous blocks, respectively). Consequently, the null joint-hypothesis was rejected, and SCB can be considered an acceptable alternative to ISB. CONCLUSIONS For acute pain control following shoulder surgery, high-quality evidence indicates that SCB can be used as an effective ISB alternative. SCB is noninferior for postoperative opioid consumption and acute pain, and it reduces the odds of postblock respiratory dysfunction.
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Affiliation(s)
- Nasir Hussain
- From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Ioana Costache
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicolas Kumar
- From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio.,Faculty of Medicine, The Ohio State University College of Medicine, Columbus, Ohio
| | - Michael Essandoh
- From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Tristan Weaver
- From the Department of Anesthesiology, The Ohio State University, Wexner Medical Center, Columbus, Ohio
| | - Patrick Wong
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Tierney
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Rose
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Colin J L McCartney
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Faraj W Abdallah
- Department of Anesthesiology and Pain Medicine, and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.,Department of Anesthesia, and the Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Balthasar AJR, Bydlon TM, Ippel H, van der Voort M, Hendriks BHW, Lucassen GW, van Geffen GJ, van Kleef M, van Dijk P, Lataster A. Optical signature of nerve tissue-Exploratory ex vivo study comparing optical, histological, and molecular characteristics of different adipose and nerve tissues. Lasers Surg Med 2018; 50:948-960. [PMID: 29756651 PMCID: PMC6220981 DOI: 10.1002/lsm.22938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 02/02/2023]
Abstract
Background During several anesthesiological procedures, needles are inserted through the skin of a patient to target nerves. In most cases, the needle traverses several tissues—skin, subcutaneous adipose tissue, muscles, nerves, and blood vessels—to reach the target nerve. A clear identification of the target nerve can improve the success of the nerve block and reduce the rate of complications. This may be accomplished with diffuse reflectance spectroscopy (DRS) which can provide a quantitative measure of the tissue composition. The goal of the current study was to further explore the morphological, biological, chemical, and optical characteristics of the tissues encountered during needle insertion to improve future DRS classification algorithms. Methods To compare characteristics of nerve tissue (sciatic nerve) and adipose tissues, the following techniques were used: histology, DRS, absorption spectrophotometry, high‐resolution magic‐angle spinning nuclear magnetic resonance (HR‐MAS NMR) spectroscopy, and solution 2D 13C‐1H heteronuclear single‐quantum coherence spectroscopy. Tissues from five human freshly frozen cadavers were examined. Results Histology clearly highlights a higher density of cellular nuclei, collagen, and cytoplasm in fascicular nerve tissue (IFAS). IFAS showed lower absorption of light around 1200 nm and 1750 nm, higher absorption around 1500 nm and 2000 nm, and a shift in the peak observed around 1000 nm. DRS measurements showed a higher water percentage and collagen concentration in IFAS and a lower fat percentage compared to all other tissues. The scattering parameter (b) was highest in IFAS. The HR‐MAS NMR data showed three extra chemical peak shifts in IFAS tissue. Conclusion Collagen, water, and cellular nuclei concentration are clearly different between nerve fascicular tissue and other adipose tissue and explain some of the differences observed in the optical absorption, DRS, and HR‐NMR spectra of these tissues. Some differences observed between fascicular nerve tissue and adipose tissues cannot yet be explained but may be helpful in improving the discriminatory capabilities of DRS in anesthesiology procedures. Lasers Surg. Med. 50:948–960, 2018. © 2018 The Authors. Lasers in Surgery and Medicine Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Andrea J R Balthasar
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Hans Ippel
- Department of Biochemistry, Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | | | - Benno H W Hendriks
- Philips Research, Eindhoven, The Netherlands.,Delft University of Technology, Department of BioMechanical Engineering, Delft, The Netherlands
| | | | - Geert-Jan van Geffen
- Department of Anesthesiology, University Medical Center St. Radboud, Nijmegen, The Netherlands
| | - Maarten van Kleef
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul van Dijk
- Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Arno Lataster
- Department of Anatomy and Embryology, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Jeong JS, Kim YJ, Woo JH, Kim CH, Chae JS. A retrospective analysis of neurological complications after ultrasound guided interscalene block for arthroscopic shoulder surgery. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.2.184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ji Sun Jeong
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Youn Jin Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Jae-Hee Woo
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Chi Hyo Kim
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea
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Chumnanvej S, Kittayapirom K, Chumnanvej S. Visualization of Needle-Tip Localization by Ultrasound Guidance with Contrast Bubble in Lumbar Selective Nerve Root Block: Clinical Pilot Study. World Neurosurg 2017; 111:e418-e423. [PMID: 29274452 DOI: 10.1016/j.wneu.2017.12.079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/11/2017] [Accepted: 12/13/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Epidural steroid injection for low back and leg pain has been shown to result in a positive clinical outcome. Lumbosacral selective nerve root block (SNRB) via a transforaminal approach is commonly performed under fluoroscopic guidance. However, ultrasound guidance is an alternative to overcome the radiologic disadvantages. This study examined the accuracy of needle-tip localization under ultrasound guidance with a contrast bubble, compared with fluoroscopic guidance. OBJECTIVE The primary objectives were to envisage the needle-tip localization with an air bubble by ultrasound and also to determine the accuracy of needle-tip location in transforaminal lumbar SNRB for low back and leg pain patients who were not surgical candidates. METHODS A prospective study of 30 SNRBs was conducted. An air bubble was produced and was used to envisage the needle-tip location under ultrasound guidance. Finally, the needle tip was confirmed by fluoroscopy. The accuracy of needle-tip location was statistically analyzed. RESULTS Twenty-four SNRBs were performed at L4-5 and 6 SNRBs at L3-4. The accuracy of needle-tip localization was 80%. CONCLUSION In order to avoid radiation exposure during the SNRB procedure, ultrasound guidance might be an alternative. Despite being accepted practice, there is a steep learning curve involved in the use of ultrasound guidance for lumbar SNRB, and proper training is crucial. A contrast bubble is a prospective enhancement for better visualization of ultrasound guidance.
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Affiliation(s)
- Sorayouth Chumnanvej
- Neurosurgery Division, Surgery Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kitipat Kittayapirom
- Neurosurgery Division, Surgery Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Siriluk Chumnanvej
- Department of Anesthesiology, Phramongkutklao Hospital, Bangkok, Thailand.
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Abstract
Abstract
Background
Interscalene block provides optimal shoulder surgery analgesia, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block was recently proposed as an interscalene block alternative, but evidence of its comparative analgesic effect is conflicting. This meta-analysis compares the analgesic effect and safety of suprascapular block versus interscalene block for shoulder surgery.
Methods
Databases were searched for randomized trials comparing interscalene block with suprascapular block for shoulder surgery. Postoperative 24-h cumulative oral morphine consumption and the difference in the area under curve for pooled rest pain scores were designated as primary outcomes. Analgesic and safety outcomes, particularly block-related and respiratory complications, were evaluated as secondary outcomes. Results were pooled using random-effects modeling.
Results
Data from 16 studies (1,152 patients) were analyzed. Interscalene block and suprascapular block were not different in 24-h morphine consumption. The difference in area under the curve of pain scores for the 24-h interval favored interscalene block by 1.1 cm/h, but this difference was not clinically important. Compared with suprascapular block, interscalene block reduced postoperative pain but not opioid consumption during recovery room stay by a weighted mean difference (95% CI) of 1.5 cm (0.6 to 2.5 cm; P < 0.0001). Pain scores were not different at any other time. In contrast, suprascapular block reduced the odds of block-related and respiratory complications.
Conclusions
This review suggests that there are no clinically meaningful analgesic differences between suprascapular block and interscalene block except for interscalene block providing better pain control during recovery room stay; however, suprascapular block has fewer side effects. These findings suggest that suprascapular block may be considered an effective and safe interscalene block alternative for shoulder surgery.
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Rojas-Gómez MF, Blanco-Dávila R, Tobar Roa V, Gómez González AM, Ortiz Zableh AM, Ortiz Azuero A. Regional anesthesia guided by ultrasound in the pudendal nerve territory. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rcae.2017.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Anestesia regional guiada por ultrasonido en territorio del nervio pudendo. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1016/j.rca.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Regional anesthesia guided by ultrasound in the pudendal nerve territory☆. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2017. [DOI: 10.1097/01819236-201707000-00006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Chandra A, Eisma R, Felts P, Munirama S, Corner GA, Demore CEM, McLeod G. The feasibility of micro-ultrasound as a tool to image peripheral nerves. Anaesthesia 2016; 72:190-196. [DOI: 10.1111/anae.13708] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 01/14/2023]
Affiliation(s)
- A. Chandra
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
| | - R. Eisma
- Centre for Anatomy and Human Identification; University of Dundee; Dundee UK
| | - P. Felts
- Centre for Anatomy and Human Identification; University of Dundee; Dundee UK
| | - S. Munirama
- Department of Anaesthesia; Manchester Royal Infirmary; Manchester UK
| | - G. A. Corner
- School of Engineering, Physics and Mathematics; University of Dundee; Dundee UK
| | - C. E. M. Demore
- Institute for Medical Science and Technology; University of Dundee; Dundee UK
- Sunnybrook Research Institute; Toronto Ontario Canada
| | - G. McLeod
- Department of Anaesthesia; Ninewells Hospital; Dundee UK
- Institute for Academic Anaesthesia; University of Dundee; Dundee UK
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Abstract
OBJECTIVE The aim of this article is to provide an overview of peripheral nerve blocks, the use of peripheral nerve block within and outside interventional radiology, and the complications of peripheral nerve block. CONCLUSION Interventional radiologists are often responsible for sedation and pain management in the majority of interventional radiology procedures. Peripheral nerve block is increasingly being used in interventional radiology.
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The Second American Society of Regional Anesthesia and Pain Medicine Evidence-Based Medicine Assessment of Ultrasound-Guided Regional Anesthesia. Reg Anesth Pain Med 2016; 41:181-94. [DOI: 10.1097/aap.0000000000000331] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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