Investigation of a New Echogenic Needle for use with Ultrasound Peripheral Nerve Blocks

Deam, R.; Kluger, Roman; Barrington, MJ; McCutcheon, Craig

doi:10.1177/0310057x0703500419

Cited by 59 publications

(30 citation statements)

References 3 publications

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“…Nevertheless, this model has been the training ground for many UGRA practitioners and has been used as the testing medium in several needle visibility studies. 28,29 The elastomeric rubber molds well to the ''smooth'' shafts of traditional needles, but many of the recent echogenic technologies depend on texturing of the needle surface. In human tissue, it is assumed that fluid fills these indentations to achieve a tissuemetal interface for the reflection of the ultrasound waves.…”

Section: Pros and Consmentioning

confidence: 99%

A Review of the Benefits and Pitfalls of Phantoms in Ultrasound-Guided Regional Anesthesia

Hocking

Hebard

Mitchell

2011

Regional Anesthesia and Pain Medicine

123

112

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With the growth of ultrasound-guided regional anesthesia, so has the requirement for training tools to practice needle guidance skills and evaluate echogenic needles. Ethically, skills in ultrasound-guided needle placement should be gained in a phantom before performance of nerve blocks on patients in clinical practice. However, phantom technology is varied, and critical evaluation of the images is needed to understand their application to clinical use. Needle visibility depends on the echogenicity of the needle relative to the echogenicity of the tissue adjacent the needle. We demonstrate this point using images of echogenic and nonechogenic needles in 5 different phantoms at both shallow angles (20 degrees) and steep angles (45 degrees). The echogenicity of phantoms varies enormously, and this impacts on how needles are visualized. Water is anechoic, making all needles highly visible, but does not fix the needle to allow practice placement. Gelatin phantoms and Blue Phantoms provide tactile feedback but have very low background echogenicity, which greatly exaggerates needle visibility. This makes skill acquisition easier but can lead to false confidence in regard to clinical ability. Fresh-frozen cadavers retain much of the textural feel of live human tissue and are nearly as echogenic. Similar to clinical practice, this makes needles inserted at steep angles practically invisible, unless they are highly echogenic. This review describes the uses and pitfalls of phantoms that have been described or commercially produced.

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Section: Pros and Consmentioning

confidence: 99%

A Review of the Benefits and Pitfalls of Phantoms in Ultrasound-Guided Regional Anesthesia

Hocking

Hebard

Mitchell

2011

Regional Anesthesia and Pain Medicine

123

112

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“…5,10 Studies in synthetic and cadaveric UGRA phantom media demonstrate that echogenic needle designs have the potential to offer improved visibility and accuracy. 6,8,12 However, the results of needle studies in phantom media need to be interpreted with caution because appearances in live human tissue can be very different. 13 We compared the Pajunk Sonoplex Nanoline echogenic needle (Pajunk Medizintechnologie, Geisingen, Germany) against our standard nerve block needle, the Pajunk Uniplex Nanoline, in patients undergoing femoral and/or sciatic nerve block as part of their routine anesthetic management.…”

mentioning

confidence: 99%

Echogenic Technology Can Improve Needle Visibility During Ultrasound-Guided Regional Anesthesia

Hebard

Hocking

2011

Regional Anesthesia and Pain Medicine

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Needle tip visualization is fundamental to the safety and efficacy of ultrasound-guided regional anesthesia (UGRA). It can be extremely challenging especially at steep insertion angles. We assessed whether an echogenic needle improved tip visibility during UGRA by anesthesiologists performing their normal in-plane technique. The visibility of the Pajunk Sonoplex (echogenic) and the Pajunk Uniplex (control) needle were compared during 60 nerve blocks (30 femoral, 30 sciatic) in this randomized controlled trial. All ultrasound imaging was recorded for analysis. The anesthesiologist subjectively estimated the percentage time they had visualized the needle tip (5-point scale: 1 [0%-20%], 2 [20%-40%], 3 [40%-60%], 4 [60%-80%], 5 [80%-100%]). The actual time the tip was in view, angle of needle insertion, target depth, and procedure time were subsequently measured objectively by a single investigator. The Sonoplex group had both subjectively and objectively better tip visibility (P=0.002), despite having larger mean body mass index (29.0 vs 25.0 kg/m(2), P=0.01) and steeper mean insertion angle (31 vs 22 degrees, P=0.03). Objective percentage tip visibility, during in-plane UGRA, reduced by 12% for every 10-degree increase in insertion angle with the control. Tip visibility with the Sonoplex was independent of insertion angle over the range studied (0-57 degrees, P=0.95). This finding occurred when nonexpert anesthesiologists performed their standard UGRA technique. A needle that is visible for a greater percentage of time has potential safety and efficacy implications.

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“…The Tuohy Sono needle (Pajunk, Geisingen, Germany), for instance, has ''Cornerstone'' reflectors covering the distal portion of the cannula, creating a higher acoustic impedance compared with the surrounding tissue. Although such echogenic needles have been reported to have enhanced needle tip and shaft visibility (Deam et al 2007;Hebard and Hocking 2011;Menhadji et al 2013;Sviggum et al 2013), they typically are more expensive and represent a relatively small percentage of needles used clinically. Most standard needles in clinical use continue to be made from smooth stainless steel with steel or plastic styluses.…”

Section: Introductionmentioning

confidence: 99%

Needle Trajectory and Tip Localization in Real-Time 3-D Ultrasound Using a Moving Stylus

Beigi

Rohling

Salcudean

et al. 2015

Ultrasound in Medicine & Biology

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Investigation of a New Echogenic Needle for use with Ultrasound Peripheral Nerve Blocks

Cited by 59 publications

References 3 publications

A Review of the Benefits and Pitfalls of Phantoms in Ultrasound-Guided Regional Anesthesia

A Review of the Benefits and Pitfalls of Phantoms in Ultrasound-Guided Regional Anesthesia

Echogenic Technology Can Improve Needle Visibility During Ultrasound-Guided Regional Anesthesia

Needle Trajectory and Tip Localization in Real-Time 3-D Ultrasound Using a Moving Stylus

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