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Kim E, Choi CH, Lim JA, Lee SY, Choi E, Kim J. Eighth Cervical Nerve Root Block During Interscalene Brachial Plexus Block Decreases Pain Caused by Posterior Portal Placement but Increases Horner Syndrome in Patients Undergoing Arthroscopic Shoulder Surgery: A Randomized Controlled Trial. Arthroscopy 2024; 40:217-228.e4. [PMID: 37355189 DOI: 10.1016/j.arthro.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/07/2023] [Accepted: 06/05/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To compare the intensity of pain on posterior portal placement between a C5-C7 root block (conventional interscalene brachial plexus block [ISBPB]) and a C5-C8 root block in patients undergoing arthroscopic shoulder surgery. METHODS In this prospective, single-blinded, parallel-group randomized controlled trial, patients were randomized to receive either a C5-C7 root block (C5-C7 group, n = 37) or a C5-C8 root block (C5-C8 group, n = 36) with 25 mL of 0.75% ropivacaine. The primary outcome was the pain intensity on posterior portal placement, which was graded as 0 (no pain), 1 (mild pain), or 2 (severe pain). The secondary outcomes were the bilateral pupil diameters measured 30 minutes after ISBPB placement; the incidence of Horner syndrome, defined as a difference in pupil diameter (ipsilateral - contralateral) of less than -0.5 mm; the onset of postoperative pain; and the postoperative numerical rating pain score, where 0 and 10 represent no pain and the worst pain imaginable, respectively. RESULTS Fewer patients reported mild or severe pain on posterior portal placement in the C5-C8 group than in the C5-C7 group (9 of 36 [25.0%] vs 24 of 37 [64.9%], P = .003). Less pain on posterior portal placement was reported in the C5-C8 group than in the C5-C7 group (median [interquartile range], 0 [0-0.75] vs 1 [0-1]; median difference [95% confidence interval], 1 [0-1]; P = .001). The incidence of Horner syndrome was higher in the C5-C8 group than in the C5-C7 group (33 of 36 [91.7%] vs 22 of 37 [59.5%], P = .001). No significant differences in postoperative numerical rating pain scores and onset of postoperative pain were found between the 2 groups. CONCLUSIONS A C5-C8 root block during an ISBPB reduces the pain intensity on posterior portal placement. However, it increases the incidence of Horner syndrome with no improvement in postoperative pain compared with the conventional ISBPB (C5-C7 root block). LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Eugene Kim
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, College of Medicine, Hanyang University, Seoul, Republic of Korea
| | - Chang Hyuk Choi
- Department of Orthopedic Surgery, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jung A Lim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - So Young Lee
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Eunjoo Choi
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea
| | - Jonghae Kim
- Department of Anesthesiology and Pain Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Republic of Korea.
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Malamal G, Schwab HM, Panicker MR. Enhanced Needle Visualization With Reflection Tuned Apodization Based on the Radon Transform for Ultrasound Imaging. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2023; 70:1482-1493. [PMID: 37721881 DOI: 10.1109/tuffc.2023.3316284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
In ultrasound (US)-guided interventions, accurately tracking and visualizing needles during in-plane insertions are significant challenges due to strong directional specular reflections. These reflections violate the geometrical delay and apodization estimations in the conventional delay and sum beamforming (DASB) degrading the visualization of needles. This study proposes a novel reflection tuned apodization (RTA) to address this issue and facilitate needle enhancement through DASB. The method leverages both temporal and angular information derived from the Radon transforms of the radio frequency (RF) data from plane-wave imaging to filter the specular reflections from the needle and their directivity. The directivity information is translated into apodization center maps through time-to-space mapping in the Radon domain, which is subsequently integrated into DASB. We assess the influence of needle angulations, projection angles in the Radon transform, needle gauge sizes, and the presence of multiple specular interfaces on the approach. The analysis shows that the method surpasses conventional DASB in enhancing the image quality of needle interfaces while preserving the diffuse scattering from the surrounding tissues without significant computational overhead. The work offers promising prospects for improved outcomes in US-guided interventions and better insights into characterizing US reflections with Radon transforms.
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Koehler P, Otero PE, Chiavaccini L, Romano M, Stern AW, Cavalcanti M, Portela DA. A non-inferiority study comparing the ultrasound-guided parasacral with a novel greater ischiatic notch plane approach in canine cadavers. Vet Anaesth Analg 2023; 50:439-445. [PMID: 37331905 DOI: 10.1016/j.vaa.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/05/2023] [Accepted: 05/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE To describe the gross and ultrasound anatomy of the parasacral region and an ultrasound-guided greater ischiatic notch (GIN) plane approach aimed at staining the lumbosacral trunk (LST) in canine cadavers. To evaluate if the ultrasound-guided GIN plane approach is non-inferior to the previously described ultrasound-guided parasacral approach at staining the LST. STUDY DESIGN Prospective, randomized, non-inferiority experimental anatomic study. ANIMALS A total of 17 (23.9 ± 5.2 kg) mesocephalic canine cadavers. METHODS Anatomic and echographic landmarks, and the feasibility of performing a GIN plane technique were evaluated using two canine cadavers. The remaining 15 cadavers had each hemipelvis randomly assigned to be administered either parasacral or GIN plane injection of 0.15 mL kg-1 dye solution. The parasacral region was dissected after injections to assess the staining of LST, cranial gluteal nerve, pararectal fossa and pelvic cavity. The stained LST were removed and processed for histological evaluation of intraneural injections. A one-sided z-test for non-inferiority (non-inferiority margin -14%) was used to statistically evaluate the success of the GIN plane versus the parasacral approach. Data were considered statistically significant when p < 0.05. RESULTS The GIN plane and parasacral approach stained the LST in 100% and 93.3% of the injections, respectively. The success rate difference between treatments was 6.7% [95% confidence interval, -0.6 to 19.0%; p < 0.001 for non-inferiority]. The GIN plane and parasacral injections stained the LST for 32.7 ± 16.8 mm and 43.1 ± 24.3 mm, respectively (p = 0.18). No evidence of intraneural injection was found. CONCLUSIONS AND CLINICAL RELEVANCE The ultrasound-guided GIN plane technique resulted in nerve staining that was non-inferior to the parasacral technique and may be considered an alternative to the parasacral approach to block the LST in dogs.
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Affiliation(s)
- Perry Koehler
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Pablo E Otero
- Department of Anesthesiology and Pain Management, Facultad de Ciencias Veterinarias, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ludovica Chiavaccini
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Marta Romano
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Adam W Stern
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Mariana Cavalcanti
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA
| | - Diego A Portela
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, USA.
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Brasileiro ACL, Silva AVCGE, Garcia AL, Furtado BRCDM, Araújo FAP, Diniz LN, Silva LCME, Lima LADC. Needle visualization during ultrasound-guided puncture: image optimization. J Vasc Bras 2023; 22:e20230038. [PMID: 37576736 PMCID: PMC10421575 DOI: 10.1590/1677-5449.202300382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/01/2023] [Indexed: 08/15/2023] Open
Abstract
Background Obtaining an adequate image of the needle by ultrasound reduces complications resulting from punctures, increasing patient safety and reducing hospitalization costs. Objectives To verify human perception in relation to number of pixels, while also identifying the best puncture angle and which needle should be used, and to evaluate whether there is a difference if needle visualization software is used. Methods 20 images were analyzed by 103 students who classified them as being sufficient or insufficient and were compared with the quality observed using photoshop. We evaluated whether there were differences between puncture angles of less than 45º and more than 45º, between IV catheter and introducer needles, and between images obtained with and without visualization software. Results There was a higher percentage of sufficient ratings for images those that had more than 60 pixels and when the puncture angle was less than 45º, with significant associations between students' evaluations and each of these groups (p < 0.001). The percentages of images classified as sufficient were higher for images in which a IV catheter was used and also higher for those using the needle visualization software, with significant associations between the results for students' classifications and each of these groups (p < 0.001). Conclusions The human eye classifies an image as sufficient according to higher numbers of pixels. Images of punctures at angles smaller than 45º in relation to the surface, of punctures performed with a IV catheter, and when using specific visualization software are also better detected by the human eye.
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Malamal G, Panicker MR. On the physics of ultrasound transmission for in-plane needle tracking in guided interventions. Biomed Phys Eng Express 2023; 9. [PMID: 36898145 DOI: 10.1088/2057-1976/acc338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/10/2023] [Indexed: 03/12/2023]
Abstract
Objective.In ultrasound (US) guided interventions, the accurate visualization and tracking of needles is a critical challenge, particularly during in-plane insertions. An inaccurate identification and localization of needles lead to severe inadvertent complications and increased procedure times. This is due to the inherent specular reflections from the needle with directivity depending on the angle of incidence of the US beam, and the needle inclination.Approach.Though several methods have been proposed for improved needle visualization, a detailed study emphasizing the physics of specular reflections resulting from the interaction of transmitted US beam with the needle remains to be explored. In this work, we discuss the properties of specular reflections from planar and spherical wave US transmissions respectively through multi-angle plane wave (PW) and synthetic transmit aperture (STA) techniques for in-plane needle insertion angles between 15°-50°.Main Results.The qualitative and quantitative results from simulations and experiments reveal that the spherical waves enable better visualization and characterization of needles than planar wavefronts. The needle visibility in PW transmissions is severely degraded by the receive aperture weighting during image reconstruction than STA due to greater deviation in reflection directivity. It is also observed that the spherical wave characteristics starts to alter to planar characteristics due to wave divergence at large needle insertion depths.Significance.The study highlights that synergistic transmit-receive imaging schemes addressing the physical properties of reflections from the transmit wavefronts are imperative for the precise imaging of needle interfaces and hence have strong potential in elevating the quality of outcomes from US guided interventional practices.
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Affiliation(s)
- Gayathri Malamal
- Center for Computational Imaging, Dept. of Electrical Engineering, Indian Institute of Technology Palakkad, India
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AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:E4-E18. [PMID: 30758889 DOI: 10.1002/jum.14954] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Prabhakar C, Uppal V, Sondekoppam RV. Effect of Beam Steering on Echogenic and Nonechogenic Needle Visibility at 40°, 50°, and 60° Needle Insertion Angles. Anesth Analg 2018; 126:1926-1929. [PMID: 29116966 DOI: 10.1213/ane.0000000000002618] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Currently, there is little understanding of the role of echogenic needles and beam steering at moderate angles of needle insertion. The ultrasound images of the echogenic and nonechogenic needles inserted into pork at 40°, 50°, and 60° were scored by anesthesiologists on a scale of 0-10. The effect of different levels of beam steer was also explored. At 40°, steep beam steering improves visualization of both nonechogenic and echogenic needles to an equal, satisfactory level. At 50° and 60°, visualization of nonechogenic needles is poor, whereas visibility of an echogenic needle was adequate and may be improved with steep beam steering.
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Affiliation(s)
- Christopher Prabhakar
- From the Department of Anesthesiology, Pharmacology and Therapeutics, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vishal Uppal
- Department of Anesthesia, Perioperative Medicine and Pain Management, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rakesh V Sondekoppam
- Department of Anesthesiology & Pain Medicine, University of Alberta, Edmonton, Alberta, Canada
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Reusz G, Sarkany P, Gal J, Csomos A. Needle-related ultrasound artifacts and their importance in anaesthetic practice. Br J Anaesth 2014; 112:794-802. [DOI: 10.1093/bja/aet585] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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