The new technological trends in ultrasound-guided regional anesthesia

Choquet, Olivier; Abbal, Bertrand; Capdevila, Xavier

doi:10.1097/01.aco.0000432512.15694.dd

Cited by 18 publications

(9 citation statements)

References 23 publications

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“…However, if history serves as a template, technological limitations may be transient and overcome. 19 In other words, with continued progress, clinicians could imagine a not so distant future where increasingly sophisticated machines and, possibly, 3-dimensional US 20 will permit reliable insonation of deep neural structures (eg, the lumbar and sacral plexi), 16,21 as well as narrow interlaminar vertebral windows.…”

Section: Limitations Of Ultrasound Guidancementioning

confidence: 99%

Beyond Ultrasound Guidance for Regional Anesthesiology

Tran

Boezaart

Neal

2017

Regional Anesthesia and Pain Medicine

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Despite its popularity, ultrasound (US)-guided regional anesthesiology is associated with significant limitations. The latter can be attributed to either the US machine (ie, decreased ability to insonate deep neural structures, as well as the thoracic spine) or the operator. Shortcomings associated with the operator can be explained by errors in perception (ie, ambiguous criteria for needle/catheter tip-to-nerve proximity and subparaneural local anesthetic injection) or interpretation. Perhaps the greatest confusion afflicting US-guided regional anesthesiology originates from an intellectual misconception pertaining to its application. Increasingly, authors are using US to identify interfascial planes where local anesthetic can be injected thereby "discovering" new truncal blocks. Often these novel blocks suffer from a lack of proper randomized, comparative validation.Fortunately, solutions have been proposed to remedy many shortcomings associated with US guidance. The inability of US to reliably insonate deep neural structures can be circumvented with adjunctive neurostimulation. Fluoroscopy and waveform analysis have been proven to increase the success rate of thoracic epidural blocks. For continuous nerve blocks, combined US-neurostimulation may provide an objective end point (ie, an evoked motor response) for neural proximity and subparaneural positioning of the catheter tip. Finally, the solution to the plethora of nonvalidated US-guided blocks is both elegant and simple. New nerve blocks should answer a specific clinical need, and their first descriptions should take the form of an adequately powered, observer-blinded, randomized comparison against the established standard of care or, at the very least, a large case series (eg, a Brief Technical Report).

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Section: Limitations Of Ultrasound Guidancementioning

confidence: 99%

Beyond Ultrasound Guidance for Regional Anesthesiology

Tran

Boezaart

Neal

2017

Regional Anesthesia and Pain Medicine

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“…Electromagnetic needle tracking systems which indicate the place where the needle tip will appear on an ultrasound screen under transverse imaging are available [33]. However, these will not widely spread in dialysis therapy for the time being because of cost, precision, labor demands and the size of the equipment.…”

Section: Ultrasound Equipmentmentioning

confidence: 99%

Ultrasound-guided cannulation of hemodialysis access

2016

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Because hemodialysis therapy cannot be performed without the cannulation of a vascular access, establishing a well-functioning vascular access is crucial. Recently, the number of patients with difficult arteriovenous (AV) fistula cannulation has increased due to changes in the epidemiology of the dialysis population. To address this issue, indications for real-time ultrasound-guided techniques have recently been reported. This review discusses methods of ultrasound-guided cannulation of dialysis access; it is difficult to cannulate a deep, small, or stiff vessel of an AV fistula on the first attempt with static ultrasound guidance in which the ultrasound probe remains stationary. Mastering a method in which the precise location of the needle tip can be continuously identified during the insertion by dynamic probe scanning is required. To achieve this, understanding the theory of ultrasound guidance, off/on-the-job training, and a sense of professionalism are important. The use of ultrasound also enables the safe catheter placement into a collapsed central vein and repeated direct puncture of a femoral vein. The latter reduces the risk of catheter-related blood stream infection by avoiding the use of an indwelling dual-lumen catheter. In conclusion, ultrasound-guided techniques enable precise vascular cannulation, which can result in significant patient and financial impact. The accumulation of further reports is required for the method to be acknowledged as the standard to cope with difficult vascular access for dialysis. As most of the latest ultrasound machines for procedural guidance are optimized for peripheral nerve block, a compact and affordable ultrasound device with image quality focused on vascular access is also needed.

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“…This theoretically confers an increased margin of safety as the needle path and/or tip position can be superimposed on the image of the underlying tissues. Real-time needle guidance has been shown in several studies to improve success rates and reduce procedure times for a number of interventional tasks [25][26][27][28][29][30][31][32].…”

Section: An Unmet Needmentioning

confidence: 99%

Evaluation of the eZono 4000 with eZGuide for ultrasound-guided procedures

Gadsden

Latmore

Levine

2014

Expert Review of Medical Devices

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Ultrasound-guided procedures are increasingly common in a variety of acute care settings, such as the operating room, critical care unit and emergency room. However, accurate judgment of needle tip position using traditional ultrasound technology is frequently difficult, and serious injury can result from inadvertently advancing beyond or through the target. Needle navigation is a recent innovation that allows the clinician to visualize the needle position and trajectory in real time as it approaches the target. A novel ultrasound machine has recently been introduced that is portable and designed for procedural guidance. The eZono 4000™ features an innovative needle navigation technology that is simple to use and permits the use of a wide range of commercially available needles, avoiding the inconvenience and cost of proprietary equipment. This article discusses this new ultrasound machine in the context of other currently available ultrasound machines featuring needle navigation.

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The new technological trends in ultrasound-guided regional anesthesia

Cited by 18 publications

References 23 publications

Beyond Ultrasound Guidance for Regional Anesthesiology

Beyond Ultrasound Guidance for Regional Anesthesiology

Ultrasound-guided cannulation of hemodialysis access

Evaluation of the eZono 4000 with eZGuide for ultrasound-guided procedures

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