Identifying the needle-tip position during regional anaesthesia with needle-tip pressure at different flow rates

Chandra, A.; Yan, Judy; Soenjaya, Yohannes; Démoré, Christine; Columb, Malachy O.; McLeod, G.

doi:10.1016/j.bja.2018.05.040

Cited by 3 publications

(4 citation statements)

References 1 publication

(1 reference statement)

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“…15 (Table 1). Indeed, subepineural pressures were closest to those obtained in pigs 28 and epineural pressures were closest to those obtained in patients 14; 15 .…”

Section: Discussionsupporting

confidence: 67%

“…The distribution of the opening pressure data was assessed using the D'Agostino- For Study 1, power analysis was based on comparison of paired, dependent fluid pressure data at epineurium and during intraneural injection. From a previous anaesthetised pig experiment 28 we assumed an effect size of 0.5, and two-tailed test with  error = 0.05 and  error = 0.90. We calculated (G*Power, University of Dusseldorf) that we needed at least 22 paired measurements.…”

Section: Discussionmentioning

confidence: 99%

“…The primary objective of the first study was to compare opening fluid injection pressure when the needle tip was within perineural tissue, on contact with epineurium and within subepineurium. We hypothesized, based on our previous work on anaesthetized pigs 28 , that opening fluid injection pressure at epineurium was greater than that at perineural and subepineural needle locations. We also decided to measure opening pressure on indentation of the epimysium of muscle.…”

Section: Study 1 Injection Fluid Pressure Versus Needle Tip Positionmentioning

confidence: 99%

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Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection

McLeod

Zihang

Sadler

et al. 2021

Reg Anesth Pain Med

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IntroductionAlthough administration of regional anesthesia nerve blocks has increased during the COVID-19 pandemic, training opportunities in regional anesthesia have reduced. Simulation training may enhance skills, but simulators must be accurate enough for trainees to engage in a realistic way—for example, detection of excessive injection pressure. The soft-embalmed Thiel cadaver is a life-like, durable simulator that is used for dedicated practice and mastery learning training in regional anesthesia. We hypothesized that injection opening pressure in perineural tissue, at epineurium and in subepineurium were similar to opening pressures measured in experimental animals, fresh frozen cadavers, glycol soft-fix cadavers and patients.MethodsWe systematically reviewed historical data, then conducted three validation studies delivering a 0.5 mL hydrolocation bolus of embalming fluid and recording injection pressure. First, we delivered the bolus at 12 mL/min at epimysium, perineural tissue, epineurium and in subepineurium at 48 peripheral nerve sites on three cadavers. Second, we delivered the bolus at using three infusion rates: 1 mL/min, 6 mL/min and 12 mL/min on epineurium at 70 peripheral nerve sites on five cadavers. Third, we repeated three injections (12 mL/min) at 24 epineural sites over the median and sciatic nerves of three cadavers.ResultsMean (95%) injection pressure was greater at epineurium compared with subepineurium (geometric ratio 1.2 (95% CI: 0.9 to 1.6)), p=0.04, and perineural tissue (geometric ratio 5.1 (95% CI: 3.7 to 7.0)), p<0.0001. Mean (95%) injection pressure was greater at 12 mL/min compared with 1 mL/min (geometric ratio 1.6 (95% CI: 1.2 to 2.1), p=0.005). Pressure measurements were similar in study 3 (p>0.05 for all comparisons).DiscussionWe conclude that the soft-embalmed Thiel cadaver is a realistic simulator of injection opening pressure.

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“…15 (Table 1). Indeed, subepineural pressures were closest to those obtained in pigs 28 and epineural pressures were closest to those obtained in patients 14; 15 .…”

Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Study 1 Injection Fluid Pressure Versus Needle Tip Positionmentioning

confidence: 99%

See 1 more Smart Citation

Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection

McLeod

Zihang

Sadler

et al. 2021

Reg Anesth Pain Med

View full text Add to dashboard Cite

show abstract

“…Our studies [6, 7] are consistently demonstrating cadaver resilience to repeated needle injection. Soft tissue and nerves show similar elasticity to humans [5, 27]; needle insertion feels realistic, fluid injection generates similar in‐line pressures [28], and tissues expand and relax at a similar rate seen in patients. The cadaver is providing excellent conditions for training, testing of new devices and investigation of the mechanisms of nerve damage.…”

Section: Discussionmentioning

confidence: 99%

The effect of an ultrasound‐activated needle tip tracker needle on the performance of sciatic nerve block on a soft embalmed Thiel cadaver

et al. 2020

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Summary In this study, we measured the performance of medical students and anaesthetists using a new tracker needle during simulated sciatic nerve block on soft embalmed cadavers. The tracker needle incorporates a piezo element near its tip that generates an electrical signal in response to insonation. A circle, superimposed on the ultrasound image surrounding the needle tip, changes size and colour according to the position of the piezo element within the ultrasound beam. Our primary objective was to compare sciatic block performance with the tracker switched on and off. Our secondary objectives were to record psychometrics, procedure efficiency, participant self‐regulation and focused attention using eye‐tracking technology. Our primary outcome measures were the number of steps successfully performed and the number of errors committed during each block. Videos were scored by trained experts using validated checklists. Sequential tracker activation and deactivation was randomised equally within subjects. With needle activation, steps improved in 10 (25%) subjects and errors reduced in six (15%) subjects. The most important steps were: needle tip identification before injection, OR (95%CI) 2.12 (1.61–2.80; p < 0.001); and needle tip identification before advance of the needle, 1.80 (1.36–2.39; p < 0.001). The most important errors were: failure to identify the needle tip before injection, 2.40 (1.78–3.24; p < 0.001); and failure to quickly regain needle tip position when tip visibility was lost, 2.03 (1.5–2.75; p < 0.001). In conclusion, needle‐tracking technology improved performance in a quarter of subjects.

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Needle insertion forces and fluid injection pressures during targeting of nerves in a soft embalmed cadaver model

Zhang

McLeod

Sadler

et al. 2021

J Clin Monit Comput

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Identifying the needle-tip position during regional anaesthesia with needle-tip pressure at different flow rates

Cited by 3 publications

References 1 publication

Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection

Validation of the soft-embalmed Thiel cadaver as a high-fidelity simulator of pressure during targeted nerve injection

The effect of an ultrasound‐activated needle tip tracker needle on the performance of sciatic nerve block on a soft embalmed Thiel cadaver

Needle insertion forces and fluid injection pressures during targeting of nerves in a soft embalmed cadaver model

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