Abbal B, Choquet O, Gourari A, Bouic N, Massone A, Biboulet P, Bringuier S, Capdevila X
Department of Anesthesiology and Critical Care Medicine, Montpellier University Hospital and University Montpellier 1, Montpellier, France -
Minerva Anestesiol. 2015 Apr;81(4):369-78. Epub 2014 Jul 24.
We prospectively evaluated the effect of insertion angle on the visibility of echogenic and nonechogenic needles in phantoms and in axillary nerve blocks in patients.
Conventional and echogenic needles were studied in phantoms at insertion angles of 0-30°, 30-45°, and ≥ 45°. Operators rated comfort and image quality during the procedure and experts blinded to the needle groups randomly analyzed videos for tip and shaft visibility, surrounding tissue visibility, sharpness of the needle surface, and percentage of time with the needle completely visible. Patients scheduled for axillary nerve block were prospectively enrolled in the clinical study. Needle insertion angles were 0-30° for the median nerve approach, 30-45° for the radial nerve, and ≥ 45° for the musculocutaneous nerve. The same needle parameters were analyzed during the procedure and on videos.
Physician comfort and image quality were significantly better for echogenic needles for phantoms and patients at 30-45° and ≥ 45° insertion angles. Needle tip and shaft visibility at 30-45° and ≥ 45° insertion angles in phantoms and for the musculocutaneous nerve in patients were significantly improved, as well as the percentage with complete needle visualization during the procedure. Tissue visibility and needle sharpness were significantly superior for conventional needles. There were no differences concerning block parameters and adverse events.
Needles with enhanced echogenicity improved physician comfort, image quality, needle visibility, and visualization time of the needle during ultrasound-guided procedures in phantoms and axillary nerve blocks using insertion angles of 30-45° and ≥ 45°.
我们前瞻性地评估了进针角度对模拟体以及患者腋神经阻滞中回声针和非回声针可视性的影响。
在模拟体中研究传统针和回声针在0 - 30°、30 - 45°和≥45°进针角度下的情况。操作人员在操作过程中对舒适度和图像质量进行评分，对针组不知情的专家随机分析视频，以评估针尖和针杆的可视性、周围组织的可视性、针表面的清晰度以及针完全可视的时间百分比。计划进行腋神经阻滞的患者被前瞻性纳入临床研究。正中神经进针角度为0 - 30°，桡神经为30 - 45°，肌皮神经为≥45°。在操作过程中和视频中分析相同的针参数。
对于模拟体和患者，在30 - 45°和≥45°进针角度下，回声针的医生舒适度和图像质量明显更好。在模拟体中以及患者的肌皮神经阻滞中，30 - 45°和≥45°进针角度下的针尖和针杆可视性显著提高，操作过程中针完全可视的百分比也显著提高。传统针的组织可视性和针的清晰度明显更优。在阻滞参数和不良事件方面没有差异。
在模拟体和使用30 - 45°和≥45°进针角度的腋神经阻滞超声引导操作中，增强回声性的针改善了医生舒适度、图像质量、针的可视性以及针的可视时间。
