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Dinges HC, Hoeft J, Cornelius VM, Steinfeldt T, Wiesmann T, Wulf H, Schubert AK. Nominal logistic regression analysis of variables determining needle visibility in ultrasound images - a full factorial cadaver study. BMC Anesthesiol 2023; 23:369. [PMID: 37950214 PMCID: PMC10636954 DOI: 10.1186/s12871-023-02339-y] [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: 05/25/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Needle visualization is essential to avoid vascular puncture and nerve injury in ultrasound-guided regional anesthesia. Several factors that statistically influence needle visibility have been described but the dimensions of their individual impact remain unclear. This study aimed to quantify the impact of various independent factors on ultrasound needle visibility. METHODS A total of 1500 ultrasound videos of in-plane needle insertions were obtained in embalmed cadavers with ten different commercially available echogenic and non-echogenic needles at different insertion angles and bevel orientations in a full factorial study design. The visibility of needle tip and shaft were rated as "good" or "poor" visibility. Nominal logistic regression analyses were calculated for the visibility of the needle tip and shaft. RESULTS SonoPlex Stim Sprotte, SonoTAP Facet (needle tip and shaft) and Spinostar PencilPoint (needle tip)), insertion angle and bevel orientation were associated with good ultrasound visibility, reaching statistical significance (p < 0.05). The range of the effect on the log-odds scale for needle tip visibility was largest for the insertion angle with 6.33, followed by the tissue condition (3.76), bevel orientation (1.45) and the needle types (1.25). Regarding the needle shaft visibility, the largest effect range was observed with the insertion angle (7.36), followed by the tissue conditions with 3.96, needle type (1.86) and bevel orientation (0.95). CONCLUSION In-plane needle visibility in ultrasound images depends mainly on the insertion angle, as expected. This is closely followed by the tissue condition, which is a factor related to the patient, thus cannot be altered to improve needle visibility. In the dimensions of the log-odds scale, the choice of a specific needle is far less important towards achieving a good visualization, whereas optimizing the bevel orientation can have a larger impact than the needle choice. Concluding from the relative dimensions of factors that determine needle visibility in this model, the importance of needles with echogenic features may be overrated.
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Affiliation(s)
- Hanns-Christian Dinges
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, 35033, Baldingerstraße, Marburg, Germany.
| | - Julia Hoeft
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, 35033, Baldingerstraße, Marburg, Germany
| | - Valér Michael Cornelius
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Thorsten Steinfeldt
- Department of Anesthesiology, Intensive Care and Pain Medicine, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Thomas Wiesmann
- Department of Anesthesiology and Intensive Care Medicine, Diakoneo Diak Klinikum Schwäbisch-Hall, Schwäbisch- Hall, Germany
| | - Hinnerk Wulf
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, 35033, Baldingerstraße, Marburg, Germany
| | - Ann-Kristin Schubert
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University of Marburg, 35033, Baldingerstraße, Marburg, Germany
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Walsh CD, Ma IWY, Eyre AJ, Dashti M, Stegeman J, Dias RD, Nagdev A, Goldsmith AJ, Duggan NM. Implementing ultrasound-guided nerve blocks in the emergency department: A low-cost, low-fidelity training approach. AEM EDUCATION AND TRAINING 2023; 7:e10912. [PMID: 37817836 PMCID: PMC10560751 DOI: 10.1002/aet2.10912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023]
Abstract
Background Managing acute pain is a common challenge in the emergency department (ED). Though widely used in perioperative settings, ED-based ultrasound-guided nerve blocks (UGNBs) have been slow to gain traction. Here, we develop a low-cost, low-fidelity, simulation-based training curriculum in UGNBs for emergency physicians to improve procedural competence and confidence. Methods In this pre-/postintervention study, ED physicians were enrolled to participate in a 2-h, in-person simulation training session composed of a didactic session followed by rotation through stations using handmade pork-based UGNB models. Learner confidence with performing and supervising UGNBs as well as knowledge and procedural-based competence were assessed pre- and posttraining via electronic survey quizzes. One-way repeated-measures ANOVAs and pairwise comparisons were conducted. The numbers of nerve blocks performed clinically in the department pre- and postintervention were compared. Results In total, 36 participants enrolled in training sessions, eight participants completed surveys at all three data collection time points. Of enrolled participants, 56% were trainees, 39% were faculty, 56% were female, and 53% self-identified as White. Knowledge and competency scores increased immediately postintervention (mean ± SD t0 score 66.9 ± 8.9 vs. t1 score 90.4 ± 11.7; p < 0.001), and decreased 3 months postintervention but remained elevated above baseline (t2 scores 77.2 ± 11.5, compared to t0; p = 0.03). Self-reported confidence in performing UGNBs increased posttraining (t0 5.0 ± 2.3 compared to t1 score 7.1 ± 1.5; p = 0.002) but decreased to baseline levels 3 months postintervention (t2 = 6.0 ± 1.9, compared to t0; p = 0.30). Conclusions A low-cost, low-fidelity simulation curriculum can improve ED provider procedural-based competence and confidence in performing UGNBs in the short term, with a trend toward sustained improvement in knowledge and confidence. Curriculum adjustments to achieve sustained improvement in confidence performing and supervising UGNBs long term are key to increased ED-based UGNB use.
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Affiliation(s)
- Carrie D. Walsh
- Harvard Affiliated Emergency Medicine Residency Program, Department of Emergency MedicineMass General BrighamBostonMassachusettsUSA
| | - Irene W. Y. Ma
- Division of General Internal Medicine, Cumming School of MedicineUniversity of CalgaryAlbertaCanada
| | - Andrew J. Eyre
- Department of Emergency Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Munaa Dashti
- Department of Emergency Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Joseph Stegeman
- Harvard Affiliated Emergency Medicine Residency Program, Department of Emergency MedicineMass General BrighamBostonMassachusettsUSA
| | - Roger D. Dias
- Department of Emergency Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Arun Nagdev
- Department of Emergency MedicineHighland Hospital, Alameda Health SystemOaklandCaliforniaUSA
| | - Andrew J. Goldsmith
- Department of Emergency Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Nicole M. Duggan
- Department of Emergency Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Wang Y, Agyekum EA, Chen J, Du J, Ren Y, Zhang Q, Wang X, Xie L, Qian X. Fabrication of SEBS Block Copolymer-Based Ultrasound Phantom Containing Mimic Tumors for Ultrasound-Guided Needle Biopsy Training. ULTRASOUND IN MEDICINE & BIOLOGY 2022; 48:1143-1150. [PMID: 35341620 DOI: 10.1016/j.ultrasmedbio.2022.02.020] [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: 09/16/2021] [Revised: 02/08/2022] [Accepted: 02/20/2022] [Indexed: 06/14/2023]
Abstract
The creation of various phantoms is important in medical education, especially for intern physicians who need to practice their skills. Ultrasound phantoms are particularly useful for training in ultrasound-guided needle biopsy. SEBS, or poly(styrene-ethylene-butylene-styrene), is a thermoplastic elastomer that can be used with mineral oil to make ultrasound phantoms and a tumor-like structure. SEBS block copolymer-based phantoms are inexpensive, non-toxic and shelf-stable, and are easy to modulate. Most importantly, such ultrasound phantoms have acoustic and mechanical properties similar to those of human soft tissues. The quality of ultrasound images of phantoms and mimic tumors is excellent and can be maintained even after several biopsy needle punctures, making them excellent ultrasound phantoms for physician practice as needed.
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Affiliation(s)
- Yuguo Wang
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu, China; Department of Ultrasound, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Enock Adjei Agyekum
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China; School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Jing Chen
- QingPu Branch of Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Jing Du
- Department of Ultrasound, Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, Jiangsu, China
| | - Yongzhen Ren
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China; School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China
| | - Qing Zhang
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Xian Wang
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China
| | - Lijun Xie
- Department of Ultrasound, Zhenjiang First People's Hospital Branch, Zhenjiang, Jiangsu, China
| | - Xiaoqin Qian
- Department of Ultrasound, Jiangsu University Affiliated People's Hospital, Zhenjiang, China.
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Hovgesen CH, Wilhjelm JE, Vilmann P, Kalaitzakis E. Echogenic Surface Enhancements for Improving Needle Visualization in Ultrasound: A PRISMA Systematic Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:311-325. [PMID: 33870532 DOI: 10.1002/jum.15713] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/14/2021] [Accepted: 03/17/2021] [Indexed: 05/12/2023]
Abstract
Optimal visualization of needles in clinical ultrasound imaging is important and challenging, especially at steep angles. Improvement of visualization has been attempted with various techniques, for example, coatings and dimples. This systematic review summarizes enhancement techniques and identifies superior echogenic surface enhancements. Twenty-four papers were identified providing visibility measures for 33 different echogenic needles. These were grouped according to surface characteristics and ranked. Echogenic needles ranked higher than standard needles especially at steeper angles. Among the echogenic needles, coated needles were seemingly better visualized "in vivo" than noncoated needles, despite heterogeneity in study conditions. No unambiguous comparison revealed which needle was best visualized.
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Affiliation(s)
- Caroline Harder Hovgesen
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Jens E Wilhjelm
- Biomedical Engineering, Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Peter Vilmann
- Gastrounit, Herlev University Hospital, Herlev, Denmark
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Watanabe K, Tokumine J, Lefor AK, Nakazawa H, Yamamoto K, Karasawa H, Nagase M, Yorozu T. Photoacoustic needle improves needle tip visibility during deep peripheral nerve block. Sci Rep 2021; 11:8432. [PMID: 33875687 PMCID: PMC8055898 DOI: 10.1038/s41598-021-87777-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023] Open
Abstract
We developed a novel technology using the photoacoustic effect that improve needle tip visibility. We evaluated whether this technology improves needle tip visibility when performing a deep peripheral nerve block in a cadaver model. A photoacoustic needle was developed using a conventional echogenic needle with an intraluminal optical fiber. A pulsed laser sends light from a source through the fiber, which is converted to ultrasound at the needle tip using the photoacoustic effect. A nerve block expert performed deep nerve blocks using the photoacoustic needle and the ultrasound views recorded, with or without photoacoustic ultrasound at the needle tip. Needle tip visibility was evaluated by questionnaire (Likert scale 1: very poor, 5: very good) completed by anesthesiologists evaluating recorded images. The score was presented as median [first quartile, third quartile]. Statistical analysis was performed using the Wilcoxon matched-pairs signed rank test. The scores of needle tip visibility with photoacoustic ultrasound from the needle tip (4.3 [4.0, 4.5]) was significantly higher than that without photoacoustic ultrasound (3.5 [3.2, 3.8]) (p < 0.01). Ultrasound emitted at the needle tip using the photoacoustic effect improves needle tip visibility during deep peripheral nerve blocks. Clinical trial number University Hospital Medical Information Network Center Clinical Trials Registration System (UMIN000036974).
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Affiliation(s)
- Kunitaro Watanabe
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan.
| | - Alan Kawarai Lefor
- Department of Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan
| | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Katsuya Yamamoto
- Medical System Research & Development Center, FUJIFILM Corporation, Kanagawa, Japan
| | - Hiroyuki Karasawa
- Medical System Research & Development Center, FUJIFILM Corporation, Kanagawa, Japan
| | - Miki Nagase
- Department of Anatomy, Kyorin University Faculty of Medicine, Mitaka, Tokyo, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
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Gascon-Garcia J, Bagur-Calafat C, Girabent-Farrés M, Balius R. Validation of the range of dry needling with the fascial winding technique in the carpal tunnel using ultrasound. J Bodyw Mov Ther 2018; 22:348-353. [DOI: 10.1016/j.jbmt.2017.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/20/2017] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
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Chuan A, Lim YC, Aneja H, Duce NA, Appleyard R, Forrest K, Royse CF. A randomised controlled trial comparing meat-based with human cadaveric models for teaching ultrasound-guided regional anaesthesia. Anaesthesia 2016; 71:921-9. [DOI: 10.1111/anae.13446] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. Chuan
- Liverpool Hospital; Sydney New South Wales Australia
| | | | - H. Aneja
- Sir Charles Gairdner Hospital; Perth Western Australia Australia
| | - N. A. Duce
- Liverpool Hospital; Sydney New South Wales Australia
| | - R. Appleyard
- Macquarie University; Sydney New South Wales Australia
| | - K. Forrest
- Macquarie University; Sydney New South Wales Australia
| | - C. F. Royse
- Department of Surgery; University of Melbourne; Melbourne Victoria Australia
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Fuzier R, Casalprim J, Bataille B, Harper I, Magues JP. The echogenicity of nerve blockade needles. Anaesthesia 2014; 70:462-6. [DOI: 10.1111/anae.12977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/28/2022]
Affiliation(s)
- R. Fuzier
- Department of Anaesthesiology; Institut Claudius Regaud; IUCT-O; Toulouse France
- Pharmacoepidemiology Research Unit; INSERM 1027; University of Toulouse; Toulouse France
| | - J. Casalprim
- Department of Anaesthesiology; CHU Purpan; Toulouse France
| | - B. Bataille
- Department of Anaesthesiology and Critical Care; CH Hotel Dieu; Narbonne France
| | - I. Harper
- Department of Anaesthesiology; Wansbeck General Hospital; Ashington UK
| | - J. P. Magues
- Department of Anaesthesiology; CHU Purpan; Toulouse France
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Wiesmann T, Steinfeldt T, Volk T, Schwemmer U, Kessler P, Wulf H. [Seeing more : Technical innovations in regional anesthesia]. Anaesthesist 2014; 63:875-82. [PMID: 25398422 DOI: 10.1007/s00101-014-2381-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Visualization and verification are key factors since the implementation of ultrasound-guided regional anesthesia. This article reviews and discusses newer technical innovations in regional anesthesia with regard to optimization of needle guidance, improvements in needle visibility, technical improvements in ultrasound techniques and innovative technologies in regional anesthesia. Clinically available applications are presented as well as experimental tools and techniques with a potential for clinical implementation in the future. Mechanical needle guides are used to improve alignment of needle axis and ultrasound beam axis. Compound imaging technology improves needle visibility in steep needle insertion angles and is already implemented in daily clinical practice. Sonoelastography improves tissue discrimination and detection of small amounts of fluids. Benefits of 3D and 4D ultrasound in regional anesthesia are discussed as well as experimental tools for tissue discrimination, such as optical reflection spectrophotometry.
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Affiliation(s)
- T Wiesmann
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Philipps-Universität, Baldinger Str., 35033, Marburg, Deutschland,
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Effect of beam steering on the visibility of echogenic and non-echogenic needles: a laboratory study. Can J Anaesth 2014; 61:909-15. [DOI: 10.1007/s12630-014-0207-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 07/08/2014] [Indexed: 10/25/2022] Open
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