Uppal Vishal, Sondekoppam Rakesh V, Ganapathy Sugantha
Department of Anesthesiology and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, 339 Windermere Road, London, ON, N6A 5A5, Canada,
Can J Anaesth. 2014 Oct;61(10):909-15. doi: 10.1007/s12630-014-0207-9. Epub 2014 Jul 23.
During peripheral nerve block procedures, needle visibility decreases as the angle of needle insertion relative to skin increases due to loss of reflective signals. The primary aim of our study was to compare the effect of beam steering on the visibility of echogenic and non-echogenic block needles.
PAJUNK non-echogenic and echogenic needles were inserted into pork meat at 20°, 40°, 60°, and 70° angles, and electronic beam steering was applied at three different angles (shallow, medium, and steep) to obtain the best possible needle images. Eleven anesthesiologists blinded to the type of needle or use of beam steering scored the images obtained (0 = needle not visible; 10 = excellent needle shaft and tip visibility). Mean scores were used to classify the needles as poor visibility (mean score 0-3.3), intermediate visibility (mean score 3.4-6.6), or good visibility (mean score 6.7-10).
At 20°, the visibility scores were intermediate to good in all groups. At 40°, the mean (SD) visibility score for the non-echogenic needle improved significantly from 3.1 (1.4) to 7.9 (1.8) with application of beam steering (difference = 4.8; 95% confidence interval [CI]: 3.1 to 6.6; P < 0.001). At 60°, the mean (SD) visibility score for the non-echogenic needle was poor 0.6 (0.7) and remained poor 2.4 (1.1) with beam steering. One the other hand, the echogenic needle without beam steering 6.5 (1.8) scored significantly better than the non-echogenic needle with beam steering 2.4 (1.1) (difference = 4.2; 95% CI: 2.7 to 5.6; P < 0.001). At 70°, the mean needle visibility score was poor for the non-echogenic needle with or without beam steering. In contrast, the echogenic needle attained an intermediate visibility score with or without beam steering. Beam steering did not significantly change the visibility scores of either the echogenic or the non-echogenic needle (P = 0.088 and 0.056, respectively) at a 70° angle.
The PAJUNK echogenic needle, with or without beam steering, was more visible when compared with the non-echogenic needle at 60° and 70° angles of insertion. In contrast, at a 40° angle of needle insertion, the non-echogenic needle with beam steering was more visible compared with the echogenic needle.
在周围神经阻滞操作过程中，由于反射信号丢失，随着进针角度相对于皮肤的增加，针的可视性降低。我们研究的主要目的是比较电子束控制对回声增强型和非回声增强型阻滞针可视性的影响。
将PAJUNK非回声增强型和回声增强型针以20°、40°、60°和70°的角度插入猪肉中，并在三个不同角度（浅、中、陡）应用电子束控制以获得尽可能好的针图像。11名对针的类型或电子束控制的使用不知情的麻醉医生对获得的图像进行评分（0 = 针不可见；10 = 针杆和针尖可视性极佳）。平均分数用于将针分类为可视性差（平均分数0 - 3.3）、可视性中等（平均分数3.4 - 6.6）或可视性好（平均分数6.7 - 10）。
在20°时，所有组的可视性分数为中等至良好。在40°时，应用电子束控制后，非回声增强型针的平均（标准差）可视性分数从3.1（1.4）显著提高到7.9（1.8）（差异 = 4.8；95%置信区间[CI]：3.1至6.6；P < 0.001）。在60°时，非回声增强型针的平均（标准差）可视性分数较差，为0.6（0.7），应用电子束控制后仍较差，为2.4（1.1）。另一方面，未应用电子束控制的回声增强型针的得分6.5（1.8）显著高于应用电子束控制的非回声增强型针的得分2.4（1.1）（差异 = 4.2；95%CI：2.7至5.6；P < 0.001）。在70°时，无论有无电子束控制，非回声增强型针的平均针可视性分数都较差。相比之下，回声增强型针无论有无电子束控制都获得了中等可视性分数。在70°角度时，电子束控制对回声增强型或非回声增强型针的可视性分数均无显著影响（分别为P = 0.088和0.056）。
在60°和70°进针角度时，无论有无电子束控制，PAJUNK回声增强型针比非回声增强型针更易见。相比之下，在40°进针角度时，应用电子束控制的非回声增强型针比回声增强型针更易见。
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