Real-time Ultrasound-Guided Lumbar Epidural with Transverse Interlaminar View: Evaluation of an In-Plane Technique

Pain Medicine ◽  
2019 ◽  
Vol 20 (9) ◽  
pp. 1750-1755 ◽  
Author(s):  
Hesham Elsharkawy ◽  
Wael Saasouh ◽  
Rovnat Babazade ◽  
Loran Mounir Soliman ◽  
Jean-Louis Horn ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Anesthesia ◽  
Needle Insertion ◽  
Adult Patients ◽  
Epidural Needle ◽  
Anatomical Landmarks ◽  
Care Hospital ◽  
Open Prostatectomy ◽  
Ultrasound Guided

Abstract Objective The anatomical landmarks method is currently the most widely used technique for epidural needle insertion and is faced with multiple difficulties in certain patient populations. Real-time ultrasound guidance has been recently used to aid in epidural needle insertion, with promising results. Our aim was to test the feasibility, success rate, and satisfaction associated with a novel real-time ultrasound-guided lumbar epidural needle insertion in the transverse interlaminar view. Design Prospective descriptive trial on a novel approach. Setting Operating room and preoperative holding area at a tertiary care hospital. Subjects Adult patients presenting for elective open prostatectomy and planned for surgical epidural anesthesia. Methods Consented adult patients aged 30–80 years scheduled for open prostatectomy under epidural anesthesia were enrolled. Exclusion criteria included allergy to local anesthetics, infection at the needle insertion site, coagulopathy, and patient refusal. A curvilinear low-frequency (2–5 MHz) ultrasound probe and echogenic 17-G Tuohy needles were used by one of three attending anesthesiologists. Feasibility of epidural insertion was defined as a 90% success rate within 10 minutes. Results Twenty-two patients were enrolled into the trial, 14 (63.6%) of whom found the process to be satisfactory or very satisfactory. The median time to perform the block was around 4.5 minutes, with an estimated success rate of 95%. No complications related to the epidural block were observed over the 48 hours after the procedure. Conclusions We demonstrate the feasibility of a novel real-time ultrasound-guided epidural with transverse interlaminar view.

scholarly journals Real-time ultrasound-guided vs. anatomical landmark-guided paramedian epidural anesthesia in overweight parturients undergoing analgesic labor: a randomized controlled trial

2021 ◽  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Anesthesia ◽  
Anatomical Landmark ◽  
Ultrasound Guided ◽  
Intervertebral Space ◽  
Puncture Site ◽  
Change Rate ◽  
Procedure Duration ◽  
Total Procedure

We evaluated whether real-time ultrasound-guided epidural block is more suitable for overweight parturients undergoing analgesic labor than traditional palpation positioning. Sixty overweight at-term pregnant women (body mass index ≥30 kg/m2) with singleton pregnancy, prepared for vaginal delivery with epidural analgesia, were randomly allocated into two groups. The parturients in the anatomical landmark catheterization group received paramedian epidural anesthesia using the anatomical landmark-guided technique, while real-time ultrasound-guided positioning was performed in the ultrasound-guided-catheterization group. Total procedure duration, time to identify the puncture site and perform the puncture, first attempt success rate, number of attempts, number of needle-redirections, intervertebral-space-change rate, satisfaction score, and complications were compared between the groups. Procedure duration and time to identify the puncture site were significantly shorter in the anatomical landmark catheterization group (440.1 ± 97.2 s vs. 521.9 ± 68.4 s, p < 0.001 and 24.9 ± 13.6 s vs. 112.2 ± 15.6 s, p < 0.001, respectively). There was no significant difference in the time to perform the puncture (385.3 ± 89.7 s vs. 365.1 ± 73.0 s, p = 0.341). The first attempt success rate was lower while the number of attempts and number of needle-redirections were higher in the anatomical landmark catheterization group (p < 0.05). The intervertebral-space-change rate was similar across the groups. Satisfaction was significantly lower in the ultrasound-guided catheterization group (p = 0.009). Complication occurrence, e.g., catheterization difficulty or bleeding during catheterization, dural puncture, and lower-back pain, was similar across the groups. Real-time ultrasound-guided paramedian epidural anesthesia improved the first attempt success rate and reduced the number of attempts and number of needle-redirections in overweight parturients undergoing analgesic labor. However, the longer total procedure duration and time to identify the puncture site might dissatisfy parturients.

scholarly journals Comparison of landmark and real-time ultrasound-guided epidural catheter placement in the pediatric population: a prospective randomized comparative trial

2021 ◽  
Author(s):  
Tanya Mital ◽  
Manoj Kamal ◽  
Mritunjay Kumar ◽  
Rakesh Kumar ◽  
Pradeep Bhatia ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Epidural Catheter ◽  
Epidural Space ◽  
Pediatric Population ◽  
Comparative Trial ◽  
Epidural Needle ◽  
Ultrasound Guided ◽  
Significant Difference ◽  
The Us

Background: Epidural block placement in pediatric patients is technically challenging for anesthesiologists. The use of ultrasound (US) for the placement of an epidural catheter has shown promise. We compared landmark-guided and US-guided lumbar or lower thoracic epidural needle placement in pediatric patients.Methods: This prospective, randomized, comparative trial involved children aged 1–6 years who underwent abdominal and thoracic surgeries. Forty-five children were randomly divided into two groups using a computer-generated random number table, and group allocation was performed by the sealed opaque method into either landmark-guided (group LT) or real-time ultrasound-guided (group UT) epidural placement. The primary outcome was a comparison of the procedure time (excluding US probe preparation). Secondary outcomes were the number of attempts (re-insertion of the needle), bone contacts, needle redirection, skin-to-epidural distance using the US in both groups, success rate, and complications.Results: The median (interquartile range [IQR]) time to reach epidural space was 105.5 (297.0) seconds in group LT and 143.0 (150) seconds in group UT; P = 0.407). While the first attempt success rate was higher in the UT group (87.0% in UT vs. 40.9% in LT; P = 0.004), the number of bone contacts, needle redirections, and procedure-related complications were significantly lower. Conclusions: The use of US significantly reduced needle redirection, number of attempts, bone contact, and complications. There was no statistically significant difference in the time to access the epidural space between the US and landmark technique groups.

Role of Local Anesthesia During Lumbar Puncture in Neonates

PEDIATRICS ◽  
1993 ◽  
Vol 91 (2) ◽  
pp. 379-382 ◽  
Author(s):  
Joaquim M.B. Pinheiro ◽  
Sue Furdon ◽  
Luis F. Ochoa
Keyword(s):  
Success Rate ◽  
Lumbar Puncture ◽  
Local Anesthesia ◽  
Needle Insertion ◽  
Control Group ◽  
Anatomical Landmarks ◽  
Control Groups ◽  
Lidocaine Injection ◽  
Level Of Training ◽  
Physiologic Responses

Local anesthesia decreases physiologic responses to pain in neonates but has not been used routinely during lumbar punctures in newborns, as it might obscure anatomical landmarks. However, local anesthesia may decrease newborns' struggling during lumbar puncture, thus facilitating the procedure and increasing its success rate. The success rate of lumbar punctures was compared in neonates allocated prospectively to 0.2 to 0.5 mL of 1% lidocaine anesthesia (n = 48) or a control group (n = 52). Newborns were held in a modified lateral recumbent postion (neck not flexed) and their struggling response to the various steps in the lumbar puncture was scored by the holder. The newborns' struggling motion score increased in response to lidocaine injection, but response to the subsequent spinal needle insertion was significantly decreased. Despite this decreased motion, no differences were noted in the number of attempts per lumbar puncture (1.9 ± 0.2 [SEM] in lidocaine and 2.1 ± 0.2 in control groups), rate of lumbar puncture failure (15% in lidocaine and 19% in control groups), or the number of traumatic lumbar punctures (46% in both groups). The success rate of lumbar puncture was not dependent on level of training of physicians performing the procedure. No acute complications, cerebrospinal fluid contamination, or subsequent meningitis was noted in either group. It is concluded that local anesthesia with lidocaine decreases the degree of struggling but does not alter the success rate of lumbar puncture in neonates. The practice of withholding lidocaine anesthesia from neonates undergoing lumbar punctures cannot be justified by arguing that it makes the procedure more difficult to perform.

scholarly journals Application of Intelligent Ultrasound in Real-Time Monitoring of Postoperative Analgesic Nerve Block

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Zhengwei Li ◽  
Ling Zhao ◽  
Wutao Wang ◽  
Ling Zheng
Keyword(s):  
Brachial Plexus ◽  
Success Rate ◽  
Real Time ◽  
Nerve Block ◽  
Postoperative Analgesia ◽  
Nerve Stimulator ◽  
Ultrasound Guided ◽  
Intelligent Monitoring ◽  
Average Success Rate ◽  
Plexus Block

In order to monitor the effect of nerve block in postoperative analgesia more accurately, this paper puts forward the application research of ultrasonic real-time intelligent monitoring of nerve block in postoperative analgesia. Ultrasonic real-time intelligent monitoring of nerve block in upper limb surgery, lower limb surgery, and abdominal surgery combined with the nerve stimulator. The experiments show that there are 5 cases of adverse reactions when the nerve stimulator is only used, but no adverse reactions occur when combined with ultrasound-guided block. Continuous subclavian brachial plexus block with the ultrasound-guided nerve stimulator can clearly see the subclavian brachial plexus and its surrounding tissue structure, the direction of needle insertion in the plane, and the diffusion of narcotic drugs. The average success rate of block was up to 95.2%, which was significantly higher than that of nerve stimulator alone, and the success rate of recatheterization after the first failure was also improved. The average postoperative analgesia satisfaction was 85.6%, the average operation time was only 20 min, and the subclavian artery and pleura were avoided effectively. No pneumothorax and other complications occurred. The average success rate of ultrasound-guided subclavicular brachial plexus block in 1-2-year-old children was 97%, which was much higher than the average success rate of nerve stimulator localization with 63%. Ultrasound-guided nerve block not only directly blocks nerves under visual conditions but also helps to observe the structures around nerves and dynamically observe the diffusion of local anesthetics, which can significantly improve the accuracy and success rate of nerve block and reduce the incidence of complications.

Comparison of Ultrasound Guided Ankle Block versus Anatomical Landmark Guided Ankle Block in Minor Ankle and Foot Surgeries

2021 ◽  
Vol 15 (11) ◽  
pp. 3484-3487
Author(s):  
Muhammad Nawaz Anjum ◽  
Wajeeha Mufti ◽  
Yasser Athar Shah ◽  
Irfan Ali
Keyword(s):  
Success Rate ◽  
Regional Anesthesia ◽  
Lower Limb ◽  
Local Population ◽  
Anatomical Landmark ◽  
Anatomical Landmarks ◽  
Block Group ◽  
Ultrasound Guided ◽  
Anatomic Landmark ◽  
Lower Limb Surgery

Background: Regional anesthesia has increasingly expanded its role in perioperative care of patients undergoing foot and ankle surgery. The use of regional anesthesia has been widely implemented among anesthesiologists and pain providers. Multiple approaches for sephanous nerve blockade have been used including nerve stimulation, anatomical landmarks and ultrasound. It has been observed in previous studies that USG ankle block is more successful as compared to conventional anatomical landmark guided nerve block; so this study was planned to get precise and reliable results regarding both techniques in our local population. Objective: To compare the methods of surgical anesthesia of Ultrasound-guided ankle block versus conventional anatomic landmark-guided techniques in lower limb surgery under regional anesthesia. Materials and methods: This randomized control was carried out at Department of Anesthesia Mayo Hospital Lahore. After meeting the inclusion and exclusion criteria 50 patients (25 in each group ) were enrolled. Patients were randomly divided into two groups using lottery method. Group A patients underwent USG ankle block while group B patients underwent conventional anatomic landmark guided ankle block. Results: Mean age of patients was 46.96±11.578 years; 40(80%) patients were male and 10(20%) patients were females. Successful anesthesia was achieved in 42 (84%) patients; in which in USG block group the successful anesthesia was achieved in 22(88%) patients and in ALG block group successful anesthesia was achieved in 20(80%) patients (p value =0.702) Conclusion : Findings of this study conclude that both techniques have statistically insignificant difference in terms of success rate , however USG ankle block for surgical anesthesia showed higher success rate as compared to anatomic landmark guided technique in lower limb surgery under regional anesthesia. Keywords: Ultrasound-guided Ankle Block, Anatomic Landmark-guided Ankle Block, Lower limb surgery.

scholarly journals Ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients – a prospective observational pilot study.

2017 ◽  
Vol 5 (2) ◽  
pp. 93-96
Author(s):  
Gentle Sunder Shrestha ◽  
Sabin Koirala ◽  
Arjun Gurung ◽  
Prakash Chand
Keyword(s):  
Platelet Count ◽  
Real Time ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
International Normalized Ratio ◽  
Adult Patients ◽  
P Value ◽  
Ultrasound Guided ◽  
Margin Of Safety ◽  
The Mean

Aim: This study aims to evaluate the safety of ultrasound guided emergency cannulation of internal jugular vein in coagulopathic adult patients.Methods: Adult subjects admitted in the intensive care unit, undergoing emergency cannulation of internal jugular vein under real time ultrasonographic guidance with platelet count less than 50,000/cu mm and/or international normalized ratio (INR) more than 1.5 were enrolled. Major and minor complications during the procedure were noted.Results: Internal jugular vein was successfully cannulated in all the patients. The mean INR of patients having minor complications (provided that platelet count > 50000) was found to be 3.07 with 95% confidence interval(CI) being 2.37-3.77. The mean platelet count of patients having minor complications (provided that the INR<1.5) was found to be 27428 with 95% CI being 19428-36000. There was a significant relationship between margin of safety and occurrence of minor complications (>7mm vs 7mm or less; p value 0.027). Number of attempts while performing internal jugular vein cannulation was associated with minor complications (mean 1.5 with CI 1.2-1.78 vs mean 1.08 with 95% CI 1.00-1.25; p value 0.023). No major complications were reported during the study regardless of platelet count, INR, margin of safety or number of attempts.Conclusions: Emergency cannulation of internal jugular vein may be safely performed in coagulopathic adult patients under real-time ultrasound guidance when performed by an experienced physician.Bangladesh Crit Care J September 2017; 5(2): 93-96

scholarly journals Raman Spectroscopy Differentiates Each Tissue from the Skin to the Spinal Cord

2016 ◽  
Vol 125 (4) ◽  
pp. 793-804 ◽  
Author(s):  
T. Anthony Anderson ◽  
Jeon Woong Kang ◽  
Tatyana Gubin ◽  
Ramachandra R. Dasari ◽  
Peter T. C. So
Keyword(s):  
Raman Spectroscopy ◽  
Real Time ◽  
Diffuse Reflectance ◽  
Diffuse Reflectance Spectroscopy ◽  
Ex Vivo ◽  
Needle Insertion ◽  
Reflectance Spectroscopy ◽  
Epidural Needle ◽  
Needle Placement ◽  
Porcine Tissue

Abstract Background Neuraxial anesthesia and epidural steroid injection techniques require precise anatomical targeting to ensure successful and safe analgesia. Previous studies suggest that only some of the tissues encountered during these procedures can be identified by spectroscopic methods, and no previous study has investigated the use of Raman, diffuse reflectance, and fluorescence spectroscopies. The authors hypothesized that real-time needle-tip spectroscopy may aid epidural needle placement and tested the ability of spectroscopy to distinguish each of the tissues in the path of neuraxial needles. Methods For comparison of detection methods, the spectra of individual, dissected ex vivo paravertebral and neuraxial porcine tissues were collected using Raman spectroscopy (RS), diffuse reflectance spectroscopy, and fluorescence spectroscopy. Real-time spectral guidance was tested using a 2-mm inner-diameter fiber-optic probe-in-needle device. Raman spectra were collected during the needle’s passage through intact paravertebral and neuraxial porcine tissue and analyzed afterward. The RS tissue signatures were verified as mapping to individual tissue layers using histochemical staining and widefield microscopy. Results RS revealed a unique spectrum for all ex vivo paravertebral and neuraxial tissue layers; diffuse reflectance spectroscopy and fluorescence spectroscopy were not distinct for all tissues. Moreover, when accounting for the expected order of tissues, real-time Raman spectra recorded during needle insertion also permitted identification of each paravertebral and neuraxial porcine tissue. Conclusions This study demonstrates that RS can distinguish the tissues encountered during epidural needle insertion. This technology may prove useful during needle placement by providing evidence of its anatomical localization.

Shoulder Injections: Ultrasound

2016 ◽  
Author(s):  
Philip W. H. Peng
Keyword(s):  
Real Time ◽  
Acromioclavicular Joint ◽  
Needle Insertion ◽  
Ultrasound Guided ◽  
Accurate Localization ◽  
Long Head Of Biceps ◽  
Long Head

This chapter reviews the anatomy and ultrasound-guided techniques of various shoulder injections, including the glenohumeral joints, subacromial subdeltoid bursa, long head of biceps, and acromioclavicular joint. Ultrasonography is a very useful tool allowing accurate localization of the various target structures for shoulder injections and real-time guidance of the needle insertion. A good understanding of the anatomy and sonoanatomy is of paramount importance in performing the ultrasound-guided injections.

scholarly journals Real-time ultrasound-guided paramedian spinal anaesthesia: evaluation of the efficacy and the success rate of single needle pass

2017 ◽  
Vol 118 (5) ◽  
pp. 799-801 ◽  
Author(s):  
S.E. Chong ◽  
A. Mohd Nikman ◽  
A. Saedah ◽  
W.H. Wan Mohd Nazaruddin ◽  
Y.C. Kueh ◽  
...  
Keyword(s):  
Success Rate ◽  
Real Time ◽  
Spinal Anaesthesia ◽  
Ultrasound Guided ◽  
Needle Pass

scholarly journals Devices for accurate placement of epidural Tuohy needle for Anaesthesia administration

2014 ◽  
Vol 5 (1) ◽  
pp. 1-6 ◽  
Author(s):  
N. Vaughan ◽  
V. N. Dubey ◽  
M. Y. K. Wee ◽  
R. Isaacs
Keyword(s):  
Real Time ◽  
Video Processing ◽  
Pressure Measurement ◽  
Needle Insertion ◽  
Epidural Needle ◽  
Computer Algorithms ◽  
Measurement Device ◽  
Body Shapes ◽  
Pressure Changes ◽  
Real Patients

Abstract. The aim of this project is to design two sterile devices for epidural needle insertion which can measure in real time (i) the depth of needle tip during insertion and (ii) interspinous pressure changes through a pressure measurement device as the epidural needle is advanced through the tissue layers. The length measurement device uses a small wireless camera with video processing computer algorithms which can detect and measure the moving needle. The pressure measurement device uses entirely sterile componenets including a pressure transducer to accurately measure syringe saline in mm Hg. The data from these two devices accurately describe a needle insertion allowing comparison or review of insertions. The data was then cross-referenced to pre-measured data from MRI or ultrasound scan to identify how ligemant thickness correlates to our measured depth and pressure data. The developed devices have been tested on a porcine specimen during insertions performed by experienced anaesthetists. We have obtained epidural pressures for each ligament and demonstrated functionality of our devices to measure pressure and depth of epidural needle during insertion. This has not previously been possible to monitor in real-time. The benefits of these devices are (i) to provide an alternative method to identify correct needle placement during the procedure on real patients. (ii) The data describing the speed, depth and pressure during insertion can be used to configure an epidural simulator, simulating the needle insertion procedure. (iii) Our pressure and depth data can be compared to pre-measured MRI and ultrasound to identify previously unknown links between epidural pressure and depth with BMI, obesity and body shapes.

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