Nerve block injection pressure monitoring

A randomized, controlled simulation study comparing single and double operator ultrasound-guided regional nerve block techniques using a gelatine-based home-made phantom

BACKGROUND

The aim of this study was to compare anesthesiology residents' acquisition of gripping and needling skills in either single-or double-operator ultrasound-guided nerve block using a hand-made phantom.

DESIGN

Prospective, randomized controlled study.

METHODS

After a tutorial session, 47 ultrasound-novice residents performed needling with double and single operator (Jedi, Bedforth, On-lock) grip techniques in each of the 3 interventional task sessions.

RESULTS

The time to perform the correct grip and needling decreased significantly between sessions for each technique (P < .001). While the double operator tasks required a shorter time than the single operator tasks in all 3 sessions (P < .001), there was no significant difference between the single-operator techniques. The number of needling attempts was similar between techniques and sessions. Participants rated the workload higher for the single-operator techniques on the National Aeronautics and Space Administration Task Load Index.

CONCLUSION

Hands-on training of phantom models may be beneficial for the acquisition of single-operator grip skills.

Is Jedi Grip efficient and effective in ultrasound-guided peripheral nerve blocking? A prospective, randomized, observer-blinded study

Background

In this prospective, randomized, controlled observer-blinded study, we aimed to compare the efficacy of a single-operator technique called the Jedi Grip and a conventional technique requiring a double operator in ultrasound–guided axillary brachial plexus blocking.

Methods

Ninety-two patients (ASA I–II; aged 18–65 years old) who underwent elective hand, wrist and forearm surgery were randomly assigned to Group Conventional (C) or Group Jedi (J). In both groups, axillary plexus blockade was performed by applying 5 cc of a mixture of 10 cc of 0.5% bupivacaine and 10 cc of 2% prilocaine to the ulnar, radial, median, and musculocutaneous nerves. Parameters such as the performance time and number of needle passes were recorded during the procedure. Subsequently, a blinded observer evaluated and recorded parameters related to the blockade success. The main outcome variables were the performance time and success rate (surgical anesthesia).

Results

The block performance time of the Jedi technique was slightly longer than that of the conventional technique (220 (50), 202 (78) s, respectively) (median (IQR); p = 0.05). No significant difference was found between groups in terms of blocking success; 9 (20%) from the conventional group and 3 (6.4%) from the Jedi group were unsuccessful (p = 0.053). No differences were found in terms of arterial puncture, and no other complications occurred in either group. The motor-sensory block onset and termination times and initial analgesia requirements were similar.

Conclusion

The Jedi technique may be applied safely with similar block success and performance results as the conventional technique.

Advances in regional anaesthesia: A review of current practice, newer techniques and outcomes

Advances in ultrasound guided regional anaesthesia and introduction of newer long acting local anaesthetics have given clinicians an opportunity to apply novel approaches to block peripheral nerves with ease. Consequently, improvements in outcomes such as quality of analgesia, early rehabilitation and patient satisfaction have been observed. In this article we will review some of the newer regional anaesthetic techniques, long acting local anaesthetics and adjuvants, and discuss evidence for key outcomes such as cancer recurrence and safety with ultrasound guidance.