Differences in tip visibility and nerve block parameters between two echogenic needles during a simulation study with inexperienced anesthesia trainees

Abstract

Needle tip visualization during ultrasound-guided regional anesthesia (UGRA) is necessary for safety and efficacy. However, disruption of the image of the needle tip driven toward the target is a general problem, especially for beginners. The purpose of this study was to compare performance parameters between using the Sonoplex and Stimuplex D-Plus echogenic needles in a simulated ultrasound-guided interventional task by inexperienced anaesthesia residents. After a standardized training session, 28 anesthesiology residents performed simulated nerve blocks in a beef phantom with each needle. All ultrasound images were digitally stored for analysis. The absolute time the needle tip was in view, total procedure time, and angle of needle insertion were subsequently measured objectively by two single investigators. The procedures that used the Sonoplex echogenic needle had significantly better tip visibility and shorter total procedure time at insertion angles between 42° and 64° relative to the phantom surface. We have demonstrated that inexperienced users who used the Sonoplex echogenic needle were able to complete the procedure more quickly. Needles with improved visibility would be a very useful addition to UGRA for inexperienced users.

Phantom Study of a New Laser-Etched Needle for Improving Visibility During Ultrasonography-Guided Lumbar Medial Branch Access With Novices

“…However, polymeric-coated needles have limited usage times due to a dense cloud of micro-bubbles that are absorbed by the surrounding fluid and tissue, and dimpled tip needles are limited by low shaft visibility and remain difficult to see in many locations [11]. Taking a step forward, specific needle surface modifications allowing ultrasound reflection irrespective of angle of orientation have been recently developed in an attempt to enhance needle visualization in US for regional blocks [71421]. Sviggum et al [22] reported that the SonoPlex Stim needle (Pajunk Medical Systems, Tucker, GA, USA) was rated highest for brightness and clarity in a gel phantom compared to several echo-enhanced needles.…”

“…These indented regions increase the surface area of the needle across which the waves are reflected. These indentations between the smooth surfaces cause intense waves reflecting at different angles to bounce back to the probe by changing the reflected angles of the waves coming from the transducer [71922]. Gofeld et al [23] also noted that SonoPlex Stim appeared to have better needle tip visibility in their human cadaveric study followed by EchoStim (Havel Inc., Cincinnati, OH, USA) among representative commercially available echogenic needles in the United States.…”

“…After performing the procedure, all participants were asked to subjectively score needle visibility on a scale from 1 to 5 (1, very poor; 2, poor; 3, fair; 4, good; 5, very good) during their own performance [719]. Needle elapsed time was measured from the moment of needle stick into the phantom tissue and terminated when proper bony contact of the needle tip was visualized by ultrasound.…”

“…This development has been shown to be safe and yields better efficacy due to elimination of radiation exposure, ensuring accurate deposition and spread of local anesthetic around the target nerve [5]. Despite the numerous advantages of the use of US guidance, disruption of the image of the needle tip driven toward the target is a general problem, especially for unskilled users; the success and safety of US-guided procedures are highly dependent on needle visualization [67]. Lack of visualization of the needle during advancement in lumbar spine injections may contribute to inadvertent damage of other tissues, puncture of paraspinal vessels, and spinal anesthesia even with experienced operators [89].…”

Postoperative Analgesia Following Sciatic Nerve Blockade Administered by Nurse Anesthetists Supervised by Regional Anesthesia Faculty in an Academic Hospital

“…The small patient sample numbers in the opioid usage subgroup led to inferences that might impact clinical outcomes. Small patient sample sizes and lack of practitioner randomization with respect to level of training and regional anesthesia technical expertise as drawbacks to global evaluation of procedural proficiency has been reported in prior assessments of these skills [8,25]. Small numbers of procedural observations on large numbers of trainees have been reported as a source of methodological bias [26].…”