Articles: nerve-block.
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Anesthesia and analgesia · Jan 2020
Predicting the Depth of the Lumbar Plexus in Pediatric Patients: A Retrospective Magnetic Resonance Imaging Study.
The lumbar plexus (LP) block is commonly used for analgesia for lower extremities. If the depth of the LP (LPD) can be predicted, the performance time and procedure-related complications could be reduced. ⋯ When LP block is performed in pediatric patients, the LPD and risk of renal injury should be considered for successful and safe analgesic block.
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Randomized Controlled Trial
The effect of needle tip tracking on procedural time of ultrasound-guided lumbar plexus block: a randomised controlled trial.
Technology that facilitates performance of deep peripheral nerve blocks is of clinical interest. The Onvision™ is a new device for ultrasonographic needle tip tracking that incorporates an ultrasound sensor on the needle tip that is then represented by a green circle on the ultrasound screen. The primary aim of this study was to investigate the effect of needle tip tracking on procedural time in the first human volunteer study. ⋯ No differences were found for any other secondary outcomes. The use of Onvision needle tip tracking did not reduce procedural time for out-of-plane ultrasound-guided lumbar plexus block but did reduce the number of hand movements and path lengths. This may indicate improved needle control but further studies are needed to confirm this finding.
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Visibility of the needle tip is difficult to maintain during ultrasound-guided nerve block. A new needle has been developed that incorporates a piezo element 2-2.3 mm from the tip, activated by ultrasound. The electrical signal manifests as a coloured circle surrounding the needle tip, and allows real-time tracking. ⋯ Using the tracking needle, five correct steps improved and one error reduced. The benefits included: better identification of the needle tip before advancing the needle, OR (95%CI) 3.4 (1.6-7.7; p < 0.001); better alignment of the needle to the transducer, 3.1 (1.3-8.7; p = 0.009); and better visibility of the needle tip 3.0 (1.4-7.3; p = 0.005). In conclusion, use of the tracker needle improved the sciatic block performance of novices on the soft embalmed cadaver.
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Young individuals with chronic exercise-induced lower leg pain (ELP) who have normal compartmental muscle pressures and normal imaging occasionally suffer from a nerve entrapment syndrome. These patients have consistently undergone a variety of diagnostic tests and often futile therapies prior to arriving at the correct diagnosis. ⋯ A lower leg discomfort that is frequently present at night but worsens during exercise combined with altered foot skin sensations suggests an entrapment of the common peroneal or tibial nerve. If conservative therapies fail, neurolysis is advised.
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Regional anaesthesia involves targeting specific peripheral nerves with local anaesthetic. It facilitates the delivery of anaesthesia and analgesia to an increasingly complex, elderly and co-morbid patient population. Regional anaesthesia practice has been transformed by the use of ultrasound, which confers advantages such as accuracy of needle placement, visualisation of local anaesthetic spread, avoidance of intraneural injection and the ability to accommodate for anatomical variation. ⋯ Much research has been done, and is ongoing, with the aim of improving needle visualisation; this is also reviewed. Image interpretation requires the application of anatomical knowledge and understanding of the typical sonographic appearance of different tissues (as well as the needle). Years of practice are required to attain expertise, although it is hoped that continuing advances in nerve and needle visualisation, as described in this chapter, will expedite that process.