Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine
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Randomized Controlled Trial
Transition from nerve stimulator to sonographically guided axillary brachial plexus anesthesia in hand surgery: block quality and patient satisfaction during the transition period.
Sonographic guidance for peripheral nerve anesthesia has proven increasingly successful in clinical practice; however, fears that a change to sonographically guided regional anesthesia may impair the block quality and operating room work flow persist in certain units. In this retrospective cohort study, block quality and patient satisfaction during the transition period from nerve stimulator to sonographic guidance for axillary brachial plexus anesthesia in a tertiary referral center were investigated. ⋯ Transition from nerve stimulator to sonographic guidance for axillary brachial plexus blocks did not change block performance times or success rates. Patient satisfaction was improved even during the early institutional transition period.
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Comparative Study
Teaching a sonographically guided invasive procedure to first-year medical students using a novel finger transducer.
The exposure to ultrasound technology in medicine is increasing at multiple training levels. Ultrasound transducers have evolved to provide higher-resolution imaging for more accurate structural identification, with few improvements in ease of use. This study investigated a novel finger ultrasound transducer used by first-year medical students conducting structural identification and practicing an invasive procedure. ⋯ This study showed that first-year medical students could interpret sonographic anatomy while conducting a clinical procedure. The finger transducer proved successful in structure identification and was preferred to the classic transducer because of its combined tactile presence. This pilot study of a novel finger transducer showed the benefits of combining palpatory skills with ultrasound technology in teaching first-year medical students to perform invasive procedures.
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Injection of air under ultrasound guidance via a perineural catheter after insertion ("air test") has been described as a means to infer placement accuracy, yet this test has never been rigorously evaluated. We tested the hypothesis that the air test predicts accurate catheter location greater than chance and determined the test's sensitivity, specificity, and positive and negative predictive values using a porcine-bovine model and blinded expert in ultrasound-guided regional anesthesia. The air test improved the expert clinician's assessment of catheter tip position compared to chance, but there was no difference when compared to direct visualization of the catheter without air injection.
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In sonographic evaluations of peripheral nerves, the healthy, contralateral side may be used as an internal control for the pathologic one. Therefore, the inherent side-to-side differences must be minimal. The goal of this study was to determine the reliability of side-to-side measurements of upper extremity nerves in healthy volunteers. ⋯ In general, the healthy contralateral side can be used as an internal control considering that changes in minimum detectable differences are related to the anatomic site considered.