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Locoregional anesthesia is an essential component of multimodal analgesic and anesthetic techniques. However, few are described in rabbits, especially those aimed at the cranial abdominal wall. The aim of this study was to describe the external oblique intercostal (EOI) block technique in rabbits and compare the spread of two injectate volumes across the paracostal region and cranial abdominal wall. Eight rabbit cadavers (16 hemithoraces) were randomized to receive ultrasound-guided injections between the external abdominal oblique and external intercostal muscles. Each rabbit received 0.25 mL/kg (LV) and 0.5 mL/kg (HV) of 1% new methylene blue with immediate tissue dissection. Site of needle insertion, spread of injectate, and number of stained intercostal spaces and nerves were assessed by a blinded investigator. Injection points ranged from intercostal spaces 5–12. There were no differences between HV and LV groups in the number of covered intercostal spaces or dorsal, caudal, and total (cranial + caudal) spread. There was significantly more ventral and cranial spread in the HV group as well as staining of intercostal nerves. Injection within the EOI fascial plane successfully stained intercostal nerves associated with the thoracic wall and cranial abdomen; higher volumes provided significantly more spread in the cranial and ventral directions and stained more intercostal nerves. While the EOI block using a volume of 0.5 mL/kg could be a technique used to provide regional anesthesia of the rabbit paracostal region and cranial abdomen, future studies would be needed to determine clinical safety and efficacy. [ABSTRACT FROM AUTHOR]

Background: There are different types of real-time ultrasound (US)-guided combined spinal epidural (CSE) anesthesia techniques. We aimed to investigate the effect of real-time US-guided paramedian sagittal oblique (PSO), transverse interlaminar (TI) approach method, and landmark-guided (LG) CSE anesthesia. Methods: Ninety patients who underwent CSE block were included in the study. Patients were randomized into LG (n = 30), PSO (n = 30), and TI (n = 30) groups. The primary outcome was number of needle manipulations. The secondary outcomes are the number of attempts, needle visibility, procedure time, procedure success rate, catheter placement difficulty, posterior complex distance, and complications. Results: The number of needle manipulations was statistically significantly lower in the LG technique group (P < 0.000). When the number of attempts, the difficulty of catheter placement, and the procedure's success rate were compared between the three groups, we did not find a statistically significant difference (P > 0.05). In addition, when the procedure times were compared, the time measured for the LG group was statistically significantly lower than in the PSO and TI groups (P < 0.000). Conclusion: In the results of this study, the real-time US-guided CSE anesthesia application had a similar success and complication level with LG technique. The LG method had a shorter processing time and fewer needle manipulations.

Introduction: Upper limb surgeries frequently use the brachial plexus block for anesthetizing the limb. The conventional approach by eliciting paresthesia is a blind procedure that may have a higher failure rate and cancause damage to the nerves and nearby structures. Peripheral nerve stimulator and ultrasound techniques were introduced to aid in better localization of the nerve/plexus avoiding tissue damage. With excellent localization and increased safety margin, ultrasound has increased the success rate of supraclavicular brachial plexus block. The purpose of this study was to compare the effectiveness of a Peripheral nerve stimulator with Ultrasound for giving Supraclavicular brachial plexus block. Material and Methods: After obtaining the Institutional ethical committee approval and patient consent, a total of 60 patients were enrolled in this prospective randomized study which were randomly divided into two groups in whom Supraclavicular brachial plexus block was given using either Peripheral nerve stimulator (Group PNS) or Ultrasound (Group USG). Both groups received 15 ml 0.5% Bupivacaine and 10 ml Lignocaine with Adrenaline {2%}[1;200,000]. The chiefparameters considered were time of onset of sensory and motor block, duration of analgesia, block failure and complications following block. Results: Demographic data was comparable in both the groups. The mean time of onset of motor block and sensory blockwas found to be more in Group PNS as compared to Group USG. The duration of sensory and motor blockade was more in group PNS ascompared to group USG. The success rate of the block was higher in ultrasound group than inPNSgroup however it wasstatisticallyinsignificant. No complications occurred in either group. Conclusion: Ultrasound guidance is a safe and effective method for giving supraclavicular brachial plexus block with faster onset and more lasting duration of motor and sensory blockade. [ABSTRACT FROM AUTHOR]

Introduction: Upper limb surgeries frequently use the brachial plexus blockade method. The conventional approach of treating paresthesia is a blind procedure that may have a higher failure rate and cause damage to the nerves and nearby structures. Peripheral nerve stimulator and ultrasound techniques were introduced to help with better localization of the nerve/plexus in order to avoid some of these issues. With excellent localization and increased safety margin, ultrasound has increased the success rate of supraclavicular brachial plexus blocks. The purpose of this study was to contrast the effectiveness of a Peripheral nerve stimulator with an ultrasound-guided technique brachial plexus block. Material and Methods: After obtaining the Institutional ethical committee approval and patient consent total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: Peripheral nerve stimulator (Group PNS) and ultrasound-guided technique (Group USG). Both groups received 0.5% bupivacaine. The amount of local anesthetic injected calculated according to the body weight and was not crossing the toxic dosage (injection bupivacaine 2 mg/kg). The parameters compared between the two groups were lock execution time, time of onset of sensory and motor block, quality of sensory and motor block success rates were noted. The failed blocks were supplemented with general anesthesia. Results: Demographic data were comparable in both groups. The mean time taken for the procedure to administer a block by eliciting PNS is less compared to USG, and it was statistically significant. The mean time of onset of motor block, sensory blockade, the duration of sensory and motor blockade was statistically significant. The success rate of the block is more in ultrasound group than PNSgroup which was not clinically significant. The incidence of complications was seen more in PNS group. Conclusion: Ultrasound guidance is the safe and effective method for the supraclavicular brachial plexus block. Incidence of complications are less as ultrasound provides real-time visulaization of underlying structures and the spread of local anaesthetic. [ABSTRACT FROM AUTHOR]

Background: In pediatric catheterization, the palpation and landmark (PL) technique is widely used for femoral arterial and venous (FAV) cannulation. Over the past decade, the ultrasound‐guided (US) technique has replaced the PL technique. This study aimed to assess the clinical impact of application of the US technique on the success rate and completion time of FAV cannulation during cardiac catheterization in children. Methods: This is a retrospective observational study of consecutive pediatric patients who underwent cardiac catheterization in a tertiary care children's hospital from April 2016 to March 2022. The association between FAV cannulation success rate and the US technique was analyzed using multiple logistic regression analysis by adjusting for potential confounders, including patient and operator characteristics and procedural details. Results: A total of 749 patients (PL, 378; US, 371) were analyzed. The odds ratio (OR) of the US technique success rate for FAV cannulation was 2.03, 95% confidence interval (CI), 1.10–3.73; p = 0.02. The OR of the cannulation success rate of children aged <1 year was 0.16 (95% CI, 0.03–0.97; p = 0.046). Conclusions: The US‐guided technique was associated with an increased success rate of FAV cannulation, compared with the PL technique. Moreover, age < 1 year was an independent factor associated with a lower success rate of FAV cannulation. The US‐guided technique might be an effective procedure in FAV cannulation during cardiac catheterization in children. [ABSTRACT FROM AUTHOR]

ObjectiveThe present study aimed to assess the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife.MethodsThe author performed percutaneous A1 pulley release in 84 cadaveric hands fixed with 10% formalin. The cadaveric hands were divided into three groups: 28 hands in each group (group U: ultrasound-guided needle knife pushing group, group N: non-ultrasound-guided needle knife pushing group, group T: classical needle knife operation puncture group). Percutaneous A1 pulley release was performed, the soft tissue was dissected layer by layer, and the relevant anatomical data were measured.ResultsThe injured cases were as follows: group U, 29 (20.7%); group N, 36 (25.7%); and group T, 28 (20.0%). There is no significant difference between different tissue injury types in different intervention methods. The missed release cases were as follows: group U, 8 (5.7%); group N, 4 (2.9%); and group T, 13 (9.3%). The percentage of released A1 pulley were as follows: group U, 71.4% ± 30.7%; group N, 66.0% ± 20.3%; and group T, 61.0% ± 30.4%. The percentage of released A1 pulley of the three groups were compared: group U > group N > group T, and there was statistical difference between the three groups. The full release rates of the three groups were compared: group U(31.4%) > group N(15.7%) > group T(13.6%), and there were significant difference in the full release of A1 pulley between group U and group T, group N.ConclusionBased on the cadaver specimen, the length and percentage of released A1 pulley is longer by ultrasound-guided percutaneous A1 pulley release using a needle-knife. and there was no statistical difference in the injury rate between the three techniques.Type of Study and Clinical RelevanceClinical anatomic study. To test the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife in cadaveric hands, and provide an anatomically based support in clinic.

Background: Tarsal tunnel syndrome (TTS) is a condition in which the tibial nerve (TN) (or its terminal branches) is compressed by the flexor retinaculum (FR) and the deep fascia of the abductor hallucis muscle at the tarsal tunnel, causing symptoms that negatively impact the patient's quality of life, including numbness, a sensation of a foreign object, coldness, and pain. FR release via microtrauma using needle-knife has proven to be effective in China and is widely used by clinicians. The traditional acupotomy, however, is the "blind knife" treatment, which cannot guarantee patient safety due to risk of injury to important structures, particularly the neurovascular bundle. Compared with the conventional treatments, ultrasound-guided percutaneous FR release possesses noteworthy advantages including high efficacy and safety., Methods: Percutaneous release of the FR was performed on 51 formalin-fixed specimens. The specimens were divided into two groups: an ultrasound-guided acupotomy pushing group comprising 20 legs (group U) and a nonultrasound-guided acupotomy pushing group comprising 31 legs (group N). After high-frequency ultrasound exploration, those with clear vascular imaging were included in group U; otherwise, they were included in group N. The FR was released percutaneously, soft tissue was dissected layer by layer, and anatomical data were recorded., Results: There no cases of injury in group U (0%) and four in group N (12.9%). Among the different intervention methods, there were no significant differences in tissue injury types (χ 2 =2.80; P=0.09). The percentage of released FR in group U was 80.00% while that in group N was 61.29% (χ 2 =1.977; P=0.16), which did not represent a significant difference between the two groups. However, group U had a significantly greater release length than that in the group N ( t =3.359; P=0.002), indicating that the flexor release length guided by ultrasound is significantly greater than the unguided one., Conclusions: Ultrasound-guided percutaneous release of the FR using a needle-knife can provide greater length and percentage of released FR while maintaining a comparable safety rate to the unguided procedure., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://qims.amegroups.com/article/view/10.21037/qims-24-81/coif). The authors have no conflicts of interest to declare., (2024 Quantitative Imaging in Medicine and Surgery. All rights reserved.)

Objectives: The aim of this study was to describe the technique for a novel lateral approach to femoral nerve block in cat cadavers. Methods: Five feline cadavers were used in our prospective cadaveric experimental study. Ultrasonography was used to identify the anatomy injection site. Both pelvic limbs were injected with a volume (0.1 ml/kg) of methylene blue in each cat. The cadavers were placed in lateral recumbency, with the limb to be blocked positioned uppermost. The transducer was held perpendicular to the most proximal area of the pelvic limb, ventral to the greater trochanter and slightly cranial to the femur. Methylene blue was injected after the localisation of the femoral nerve. Immediately after the injection, the cat was turned and the technique was repeated on the contralateral side. After performing the 'block' in both limbs, the area was dissected bilaterally and the success was evaluated. A positive femoral nerve staining was considered for a coverage of ⩾1 cm. Results: A total of 10 ultrasound-guided femoral nerve injections were performed. Ninety percent (n = 9/10) of the nerves were successfully dyed. Conclusions and relevance: The novel ultrasound-guided lateral approach may be suitable and reproducible for a successful femoral nerve blockade in cats. Further investigations about the clinical usefulness and safety of this femoral nerve block in live cats are required. [ABSTRACT FROM AUTHOR]

We performed bilateral transmuscular quadratus lumborum blocks in six cadavers using iodinated contrast and methylene blue. Computed tomography imaging was performed in four cadavers and anatomical dissection was completed in five. This demonstrated spread to the lumbar paravertebral space in 63% of specimens, laterally to the transversus abdominis muscle in 50% and caudally to the anterior superior iliac spine in 63% of specimens. There was no radiographic evidence of spread to the thoracic paravertebral space. Anatomical dissection revealed dye staining of the upper branches of the lumbar plexus and the psoas major muscle in 70% of specimens. Further clinical studies are required to confirm if the quadratus lumborum block might be a suitable alternative to lumbar plexus block. [ABSTRACT FROM AUTHOR]

Background: There are different types of real-time ultrasound (US)-guided combined spinal epidural (CSE) anesthesia techniques. We aimed to investigate the effect of real-time US-guided paramedian sagittal oblique (PSO), transverse interlaminar (TI) approach method, and landmark-guided (LG) CSE anesthesia., Methods: Ninety patients who underwent CSE block were included in the study. Patients were randomized into LG ( n = 30), PSO ( n = 30), and TI ( n = 30) groups. The primary outcome was number of needle manipulations. The secondary outcomes are the number of attempts, needle visibility, procedure time, procedure success rate, catheter placement difficulty, posterior complex distance, and complications., Results: The number of needle manipulations was statistically significantly lower in the LG technique group ( P < 0.000). When the number of attempts, the difficulty of catheter placement, and the procedure's success rate were compared between the three groups, we did not find a statistically significant difference ( P > 0.05). In addition, when the procedure times were compared, the time measured for the LG group was statistically significantly lower than in the PSO and TI groups ( P < 0.000)., Conclusion: In the results of this study, the real-time US-guided CSE anesthesia application had a similar success and complication level with LG technique. The LG method had a shorter processing time and fewer needle manipulations., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Medical Ultrasound.)

Objective: To investigate a novel method for in-office fitting of intrauterine contraceptive devices (IUCDs) by comparing it to the traditional non-guided technique.Methods: A prospective cohort study comparing the application of intrauterine contraceptives was conducted between January 1, 2013 and January 31, 2015 at a university contraception clinic, in Alexandria, Egypt. Patients aged 20-45years who were parous, had previously undergone vaginal or abdominal deliveries, and were requesting device insertion were included. Patients were randomly assigned to have devices fitted using the non-guided approach, with vaginal ultrasonography to plan and confirm device placement, or by the abdominal ultrasonography-guided technique. The primary outcomes were successful IUCD insertion and ideal device position 1week after insertion. Participants, counselors, and data analysts were masked to treatment assignments.Results: Analyses included 40 patients in each treatment arm. Successful fitting was achieved in 32 (80%) patients in the non-guided arm and 39 (98%) patients in the ultrasonography-guided arm (P=0.04). Ideal placement was achieved in 38 (95%) patients in the ultrasonography-guided arm compared with 27 (68%) patients in the non-guided arm (P=0.02).Conclusion: Ultrasonography-guided IUCD insertion demonstrated improved success and fitting accuracy in comparison with a traditional, non-guided approach. ANZCTR trial ID: ACTRN12615000526572. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to assess the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife., Methods: The author performed percutaneous A1 pulley release in 84 cadaveric hands fixed with 10% formalin. The cadaveric hands were divided into three groups: 28 hands in each group (group U: ultrasound-guided needle knife pushing group, group N: non-ultrasound-guided needle knife pushing group, group T: classical needle knife operation puncture group). Percutaneous A1 pulley release was performed, the soft tissue was dissected layer by layer, and the relevant anatomical data were measured., Results: The injured cases were as follows: group U, 29 (20.7%); group N, 36 (25.7%); and group T, 28 (20.0%). There is no significant difference between different tissue injury types in different intervention methods. The missed release cases were as follows: group U, 8 (5.7%); group N, 4 (2.9%); and group T, 13 (9.3%). The percentage of released A1 pulley were as follows: group U, 71.4% ± 30.7%; group N, 66.0% ± 20.3%; and group T, 61.0% ± 30.4%. The percentage of released A1 pulley of the three groups were compared: group U > group N > group T, and there was statistical difference between the three groups. The full release rates of the three groups were compared: group U(31.4%) > group N(15.7%) > group T(13.6%), and there were significant difference in the full release of A1 pulley between group U and group T, group N., Conclusion: Based on the cadaver specimen, the length and percentage of released A1 pulley is longer by ultrasound-guided percutaneous A1 pulley release using a needle-knife. and there was no statistical difference in the injury rate between the three techniques., Type of Study and Clinical Relevance: Clinical anatomic study. To test the efficacy and safety of ultrasound-guided percutaneous A1 pulley release using a needle knife in cadaveric hands, and provide an anatomically based support in clinic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2022 Qiu, Li, Shen, Jia, Sun, Zhou, Li and Zhang.)

Objectives: With the development of percutaneously inserted devices, peripheral nerve stimulation (PNS) has been gaining attention within chronic pain literature as a less invasive neurostimulation alternative to spinal column and dorsal root ganglion stimulation. A majority of current PNS literature focuses on targeting individual distal nerves to treat individual peripheral mononeuropathies, limiting its applications. This article discusses our experience treating dermatomal pain with neurostimulation without needing to access the epidural space by targeting the proximal spinal nerve with peripheral nerve stimulation under ultrasound-guidance., Materials and Methods: A temporary, percutaneous PNS was used to target the proximal spinal nerve in 11 patients to treat various dermatomal pain syndromes in patients seen in an outpatient chronic pain clinic. Four patients received stimulation targeting the lumbar spinal nerves and seven patient received stimulation targeting the cervical or thoracic spinal nerves., Results: The case series presents 11 cases of PNS of the proximal spinal nerve. Seven patients, including a majority of the patients with lumbar radiculopathy, had analgesia during PNS. Four patients, all of whom targeted the cervical or thoracic spinal nerves, did not receive analgesia from PNS., Conclusion: PNS of the proximal spinal nerve may be an effective modality to treat dermatomal pain in patients who are not candidates for other therapies that require access to the epidural space. This technique was used to successfully treat lumbar radiculopathy, post-herpetic neuralgia, and complex regional pain syndrome., (© 2020 International Neuromodulation Society.)

Background: Percutaneous central venous cannulation in infants and children is a challenging procedure. Traditionally, an external landmark technique has been used to identify puncture site. An ultrasound-guided technique is now available and we wanted to evaluate this method in children and infants, looking specifically at the ease of use, success rate and complications. Methods: Forty-two consecutive infants and children (median 16.5 [0–177] months and 10 [3–45] kg) scheduled for central venous catheter placement were registered. An ultrasound scanner made for guiding puncture of vessels was used. After locating the puncture site, a sterile procedure was performed using an accompanying kit to aid puncture of the vessel. Results: Cannulation was successful in all patients and we had no complications during insertion of the catheters. The right internal jugular vein was preferred in most patients, and in 95% of the patients the vein was punctured at the first attempt. The median time from start of puncture to aspiration of blood was 12 (3–180) seconds. Conclusion: The ultrasound-guided technique for placement of central venous catheters was easy to apply in infants and children. It is our impression that it increased the precision and safety of the procedure in this group of patients. [ABSTRACT FROM AUTHOR]

Abstract: The combination of hypnosis and paravertebral block (PVB) was studied in three patients scheduled for breast cancer surgery. The three procedures were realized under hypnosis. Median postoperative pain was rated at zero and comfort felt at 8 on a 10 points scale. Hypnosis could be an alternative to conventional anesthesia in combination with a PVB for breast cancer surgery. [Copyright &y& Elsevier]