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Abstract Background Intrathecal injection of medications can be challenging in spinal muscular atrophy (SMA) patients with severe scoliosis or after spine surgery. Here we report our experience with real-time ultrasound (US)-guided intrathecal administration of nusinersen in patients with SMA. Methods Seven patients (six children and one adult) with either spinal fusion or severe scoliosis were enrolled. We performed intrathecal injections of nusinersen under US guidance. The efficacy and safety of US-guided injection were explored. Results Five patients had undergone spinal fusion, while the other two presented severe scoliosis. Success was achieved in 19/20 lumbar punctures (95%), 15 of which were performed through the near-spinous process approach. The intervertebral space with a designated channel was selected for the five postoperative patients, while the interspaces with the smallest rotation angle were chosen for the other two patients with severe scoliosis. In 89.5% (17/19) of the punctures, the number of insertions was no more than two. No major adverse events were observed. Conclusion Given its safety and efficacy, real-time US guidance is recommended for SMA patients with spine surgery or severe scoliosis, and the near-spinous process view can be used as a interlaminar puncture approach for US guidance.

Yifeng Shen,1,2 Qiaoyin Zhou,1,3 Xiaojie Sun,4 Shiliang Li,1,3,4 Weiguang Zhang5 1College of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, People’s Republic of China; 2Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; 3Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian University of TCM), Ministry of Education, Fuzhou, People’s Republic of China; 4Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People’s Republic of China; 5Health Science Center, Peking University, Beijing, People’s Republic of ChinaCorrespondence: Shiliang Li, Department of Acupuncture and Moxibustion, China-Japan Friendship Hospital, Beijing, People’s Republic of China, Email zrlishiliang1963@163.com Weiguang Zhang, Health Science Center, Peking University, Beijing, People’s Republic of China, Email zhangwg@bjmu.edu.cnBackground: De Quervain’s disease is a painful stenosing tenosynovitis of the first dorsal compartment of the hand affecting the tendons of the abductor pollicis longus and extensor pollicis brevis. This study aimed to evaluate the safety and efficacy of percutaneous first extensor compartment releases performed on embalmed cadaveric models by acupotomy operation with or without US guidance.Methods: Percutaneous release was performed with an acupotomy on 59 wrists of cadavers; 23 wrists were operated with US guidance, and 39 wrists were operated without US guidance. Each arm was dissected and assessed regarding the amount of release as well as the extent of neurovascular and tendon injury. Anatomical structures were also observed in this study.Results: Twenty cases (87%) were successfully released with ultrasound-assisted techniques, and 27 cases (75%) were successfully released with blind techniques. No neurovascular injury occurred in any arm, regardless of technique. No significant tendon injury was seen in any arm. Although minor surface scratches were visualized in 11 cases, they occurred in 3 cases (13.04%) with ultrasound assistance and in 8 cases (22.22%) with blind techniques. There was no statistically significant difference between the two groups in the measurement of the distance from the incision marks to the blood vessels and nerves. A fibrous septum and bony protrusions were found in the first dorsal compartment, which may be anatomical factors affecting the success of treatment.Conclusion: Both traditional and US-guided percutaneous release by acupotomy of the first extensor tendon compartment can be performed for all wrists. US-guided techniques can improve the success rate and reduce damage during acupotomy operations.Keywords: de Quervain’s disease, tendonitis, acupotomy, acupuncture, ultrasound guidance, anatomy

Abstract Objective To explore the impact of artificial-intelligence perceptual learning when performing the ultrasound-guided popliteal sciatic block. Methods This simulation-based randomized study enrolled residents who underwent ultrasound-guided sciatic nerve block training at the Department of Anesthesiology of Beijing Jishuitan Hospital between January 2022 and February 2022. Residents were randomly divided into a traditional teaching group and an AI teaching group. All residents attended the same nerve block theory courses, while those in the AI teaching group participated in training course using an AI-assisted nerve identification system based on a convolutional neural network instead of traditional training. Results A total of 40 residents were included. The complication rates of paresthesia during puncture in the first month of clinical sciatic nerve block practice after training were significantly lower in the AI teaching group than in the traditional teaching group [11 (4.12%) vs. 36 (14.06%), P = 0.000093]. The rates of paresthesia/pain during injection were significantly lower in the AI teaching group than in the traditional teaching group [6 (2.25%) vs. 17 (6.64%), P = 0.025]. The Assessment Checklist for Ultrasound-Guided Regional Anesthesia (32 ± 3.8 vs. 29.4 ± 3.9, P = 0.001) and nerve block self-rating scores (7.53 ± 1.62 vs. 6.49 ± 1.85, P

Ran Jiao,1 Shuai Peng,2 Lulu Wang,3 Man Feng,4 Youqin Li,3 Jing Sun,3 Dongyi Liu,5 Jia Fu,5 Chang Feng5 1Hospital of Shandong University, Jinan, 250100, People’s Republic of China; 2Department of Nursing, Yankuang New Journey General Hospital, Zoucheng, 273500, People’s Republic of China; 3Cheeloo College of Medicine, Shandong University, Jinan, 250102, People’s Republic of China; 4Department of Pathology, Affiliated Hospital of Shandong Academy of Medical Sciences, the Third Affiliated of Shandong First Medical University, Jinan, 250000, People’s Republic of China; 5Department of Anaesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of ChinaCorrespondence: Chang Feng, Department of Anaesthesiology, the Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Jinan, 250033, People’s Republic of China, Tel +86-17660085521, Email fengc2016@126.comPurpose: To investigate, in patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, the effects of ultrasound-guided quadratus lumborum block (UG-QLB) combined with general anaesthesia (GA) on the postoperative recovery compared with GA alone.Patients and Methods: The retrospective study enrolled 231 patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, including 119 patients who received UG-QLB combined with GA (Group QG), and 112 patients undergoing GA alone (Group GA). The primary endpoint was the postoperative 3-year recurrence-free survival (RFS). The secondary endpoints were the average visual analogue scale (VAS) scores within 48 h after surgery, the first time of postoperative ambulation, the first time of flatus, postoperative hospitalization, perioperative opioid requirement and adverse effects after surgery.Results: UG-QLB combined with GA did not affect the 3-year RFS in patients undergoing laparoscopic radical gastrectomy (HR 0.659, 95% CI 0.342– 1.269, P=0.212). However, the VAS ranking analysis implicated that it could significantly alleviate the postoperative pain in laparoscopic radical gastrectomy patients (P< 0.01). In addition, it dramatically facilitated the early recovery of postoperative ambulation and flatus, while shortening the duration of postoperative hospitalization (P< 0.01). The most important was it could remarkably reduce the opioid consumption (P< 0.01), which in the meanwhile, reduced the incidence of postoperative nausea and vomiting (PONV) (P=0.01).Conclusion: Although UG-QLB combined with GA did not improve the 3-year RFS for patients with gastric carcinoma undergoing laparoscopic radical gastrectomy, it could provide satisfactory postoperative pain relief, reduce opioid consumption and adverse effects, which subsequently facilitates postoperative early rehabilitation.Keywords: gastric adenocarcinoma, prognosis, postoperative early recovery, laparoscopic radical gastrectomy, quadratus lumborum block, ultrasound guidance

Abstract Background The aim of this study was to compare the effectiveness and safety of ultrasound-guided out-of-plane internal jugular vein (OOP-IJV) and in-plane supraclavicular subclavian vein (IP-SSCV) catheterization in adult intensive care unit. Methods A total of 250 consecutive patients requiring central venous catheterization, were randomly assigned to undergo either ultrasound-guided OOP-IJV or IP-SSCV cannulation. All catheterizations were carried out by three physicians. The primary outcome was the first attempt success rate. Ultrasound scanning time, venous puncture time, insertion time, overall access time, number of puncture attempts, number of needle redirections, success rate, guidewire advancing difficulties, venous collapse and adverse events were also documented. Results The first attempt success rate was significantly higher in IP-SSCV group (83.2%) compared to OOP-IJV group (63.2%) (p = 0.001). The IP-SSCV group was associated with a longer ultrasound scanning time (16.54 ± 13.51 vs. 5.26 ± 4.05 s; p

Embryo transfer is not just a simple process of implanting the embryos into the uterus. A successful and effective embryo transfer requires not only high-quality embryos and appropriate uterine environment, but also high technical level of embryo transfer itself. Emphasis on and mastering the embryo transfer techniques will help to increase the success rate of in vitro fertilization-embryo transfer. In this article, the role of embryo transfer techniques and clinical skills in improving pregnancy outcomes was investigated, aiming to provide practical reference for clinical practitioners.

Abstract Background Drainage is indicated in many patients with a perinephric abscess (PA). Surgical drainage is associated with trauma and slow recovery, while percutaneous drainage can be ineffective in some patients. We report on 11 patients with PA treated by percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction under local anesthesia. Methods This case series included 11 PA patients operated on from January 2013 to June 2020. All patients received percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction. Data, including operation time, volume of intraoperative blood loss, volume of intraoperative pus suction, time of postoperative drainage tube indwelling, time to restore normal body temperature, length of postoperative hospital stay, and intraoperative and postoperative complications, were collected. Results The age of the patients was 59 (53–69) years. Eight, six, two, and two patients had hypertension, type 2 diabetes, rheumatoid arthritis, and renal calculi, respectively. The operations were successful forall11 patients. Eight, two, and one patients required one, two, and three channels, respectively, to clear their abscess. The average operation time was 44 (30–65) min, and intraoperative blood loss was 16 (10–20) ml. The volume of intraoperative pus suction was 280 (200–400) ml, time of postoperative drainage tube indwelling was 8.2 (6–12) days, and time to restoring normal body temperature was 0.8 (0.5–2) days. The average postoperative hospital stay was 9.8 (7–14) days. No severe intraoperative or postoperative complications occurred. The postoperative follow-up time was typically 4.8 (3–8) months, and there were no recurrences. Conclusion Percutaneous nephroscopy combined with ultrasound-guided negative-pressure suction might be a feasible method for treating PA.

Objectives: To investigate the difference of application of core needle biopsy histology and fine needle aspiration cytology in cervical lymphadenopathy. Methods: A retrospective analysis was made on 80 patients with cervical lymphadenopathy admitted to Baoding No.1 Central Hospital from to October 2018 to February 2020, and they were randomly divided into two groups: core needle group and fine needle group. Patients in the core needle group were given core needle biopsy histology, while those in the fine needle group were given fine needle aspiration cytology, and the puncture results and surgical complications were compared between the two groups. Results: The accuracy rates of the core needle group and the fine needle group in the diagnosis of malignant cervical lymph nodes were 95.83% and 72.22% respectively, with a statistically significant difference (χ²=4.683, p=0.030). The sensitivity, specificity, positive predictive value and negative predictive value of the core needle group were 100.00%, 93.75%, 95.83% and 100.00% respectively, while those of the fine needle group were 86.67%, 90.00%, 86.67% and 90.00% respectively, with no statistically significant differences between the two groups (p>0.05). The complication rate in the core needle group was 22.50%, which was higher than the 5.00% in the fine needle group (χ²=5.165, p=0.023). Conclusions: No significant difference was observed between core needle biopsy histology and fine needle aspiration cytology in diagnosing cervical lymphadenopathy, but the former has a high complication rate. [ABSTRACT FROM AUTHOR]

Purpose: High‐dose‐rate (HDR) interstitial brachytherapy (BT) is a common treatment technique for localized intermediate to high‐risk prostate cancer. Transrectal ultrasound (US) imaging is typically used for guiding needle insertion, including localization of the needle tip which is critical for treatment planning. However, image artifacts can limit needle tip visibility in standard brightness (B)‐mode US, potentially leading to dose delivery that deviates from the planned dose. To improve intraoperative tip visualization in visually obstructed needles, we propose a power Doppler (PD) US method which utilizes a novel wireless mechanical oscillator, validated in phantom experiments and clinical HDR‐BT cases as part of a feasibility clinical trial. Methods: Our wireless oscillator contains a DC motor housed in a 3D printed case and is powered by rechargeable battery allowing the device to be operated by one person with no additional equipment required in the operating room. The oscillator end‐piece features a cylindrical shape designed for BT applications to fit on top of the commonly used cylindrical needle mandrins. Phantom validation was completed using tissue‐equivalent agar phantoms with the clinical US system and both plastic and metal needles. Our PD method was tested using a needle implant pattern matching a standard HDR‐BT procedure as well as an implant pattern designed to maximize needle shadowing artifacts. Needle tip localization accuracy was assessed using the clinical method based on ideal reference needles as well as a comparison to computed tomography (CT) as a gold standard. Clinical validation was completed in five patients who underwent standard HDR‐BT as part of a feasibility clinical trial. Needle tips positions were identified using B‐mode US and PD US with perturbation from our wireless oscillator. Results: Absolute mean ± standard deviation tip error for B‐mode alone, PD alone, and B‐mode combined with PD was respectively: 0.3 ± 0.3 mm, 0.6 ± 0.5 mm, and 0.4 ± 0.2 mm for the mock HDR‐BT needle implant; 0.8 ± 1.7 mm, 0.4 ± 0.6 mm, and 0.3 ± 0.5 mm for the explicit shadowing implant with plastic needles; and 0.5 ± 0.2 mm, 0.5 ± 0.3 mm, and 0.6 ± 0.2 mm for the explicit shadowing implant with metal needles. The total mean absolute tip error for all five patients in the feasibility clinical trial was 0.9 ± 0.7 mm using B‐mode US alone and 0.8 ± 0.5 mm when including PD US, with increased benefit observed for needles classified as visually obstructed. Conclusions: Our proposed PD needle tip localization method is easy to implement and requires no modifications or additions to the standard clinical equipment or workflow. We have demonstrated decreased tip localization error and variation for visually obstructed needles in both phantom and clinical cases, including providing the ability to visualize needles previously not visible using B‐mode US alone. This method has the potential to improve needle visualization in challenging cases without burdening the clinical workflow, potentially improving treatment accuracy in HDR‐BT and more broadly in any minimally invasive needle‐based procedure. [ABSTRACT FROM AUTHOR]

Pulsed radiofrequency (PRF) on cervical dorsal root ganglion (DRG) for pain management in cervical radicular pain is mainly performed via a transforaminal approach under fluoroscopic guidance. Ultrasound-guidance periradicular cervical nerve root intervention raises concern about the neuromodulatory effect. This study aims to evaluate the effectiveness and duration of pain relief between PRF treatment and steroid injection on the cervical nerve roots. To evaluate the efficacy of pulsed radiofrequency for cervical radicular pain. A prospective, double-blinded, randomized controlled clinical trial Patients who underwent ultrasound-guided periradicular cervical nerve root PRF or steroid injection from January 2020 to May 2021 at King Chulalongkorn Memorial Hospital (KCMH), Bangkok, Thailand. The primary outcome was the pain score at 3 months postprocedure. The secondary outcomes were the duration of pain relief of at least 50%, pain scores at other time points after pain intervention, the amount of rescue pain medications, procedural time, and complications. Forty-two patients who presented with chronic cervical radicular pain were prospectively randomized into the PRF and steroid groups. Patients in the PRF group received PRF treatment at 42°C for 4 minutes, followed by the injection of 2% lidocaine 1.5 mL and dexamethasone 10 mg to the targeted cervical nerve root. The steroid group received the same injectate. Patients and pain assessors were blinded. The numerical rating scale (NRS) and the Neck Disability Index (NDI) questionnaires were used for pain intensity and neck functional assessment before and after the procedure. Pain reduction was recorded up to a 9-month follow-up. Data analysis was obtained from 20 and 21 patients receiving PRF and steroid treatment, respectively. At 3-month postprocedure, there were 70% of patients in the PRF group reported 50% pain reduction compared with 23.8% of patients in the steroid group (p<.01). Moreover, patients in the PRF group had significantly less pain (NRS 2.8±2.7) compared with patients in the steroid group (NRS 5.5±2.6) (p=.01). The neck disability index demonstrated significant improvement at 3 and 6 months (p<.01) after PRF treatment compared with steroid injection alone. The duration, in which pain relief was at least 50%, was significantly longer in patients who received PRF treatment (6.0±4.1 months) compared with those in the steroid group (2.3±2.1 months) (p<.01). Ultrasound-guided periradicular cervical nerve root PRF exhibited a neuromodulatory effect and was considered effective for patients with cervical radicular pain. It provided a longer duration of pain relief and improvement of neck function for up to 6 months. [ABSTRACT FROM AUTHOR]

Untethered small‐scale helical devices (USHDs) have the potential to navigate blood vessels and treat vascular occlusive diseases. However, there are still many challenges in translating this method into clinical practice, both in terms of localization and wireless motion control. Herein, closed‐loop control characterization of the USHD against and along physiological fluid inside a blood vessel phantom at different penetration depths is shown. First the dynamic flow and ultrasound images noise affecting the measurement are modeled, and control system of the USHD based on bifurcation analysis of a 1D hydrodynamic model is designed. Then a region of attraction of a USHD driven by a permanent magnet robotic (PMR) system inside a blood vessel phantom around an equilibrium point is constructed. Further, the point‐to‐point closed‐loop control strategy is implemented based on the magnetic point‐dipole approximation and kinematic control of the PMR system and ultrasound feedback inside physiological fluid, blood vessel, and soft tissue. The frequency response of the USHD is characterized against and along the flowing streams of fetal bovine serum within different flow rates in the 6–20 mm s−1 range. The experimental results demonstrate the ability to navigate the USHD inside blood vessel phantoms with maximum position error of 1.99±0.55 mm. [ABSTRACT FROM AUTHOR]

Background: Lumbosacral canal stenosis is known as the most common cause of back surgery with several complications. Selecting a minimally invasive treatment with high efficacy in such patients is necessary. This study was designed to evaluate the effectiveness of ozone therapy in combination with caudal epidural steroid in patients with lumbar spinal stenosis. Methods: A double-blind randomized clinical trial was conducted on 50 patients with lumbar spinal stenosis allocated into two study groups. Under ultrasound guidance, the first group received 80 mg of triamcinolone hexavalent with 4 mL of Marcaine 0.5% and 6 mL of distilled water to the caudal epidural space. The second group received an injection similar to the first group, combined with 10 mL of ozone (O2-O3) gas at a concentration of 10 µg/cc. The patients were followed at baseline, one, and six months after injection with clinical outcomes measures using Visual Analog Scale (VAS), Walking Distance (WD) and Oswestry Disability Index (ODI). Results: The mean age of subjects, 30 males (60%) and 20 females (40%), was reported as 64.51 ± 7.19 years old. Reduction of pain intensity based on VAS score was statistically significant in both groups at follow-up periods (P < 0.001). The VAS changes in the first month and sixth months showed no significant difference between the two groups (P = 0.28 and P = 0.33, respectively). The improvement in disability index (ODI) in both types of treatment during follow-up was significant (P < 0.0001), and there was no difference between the two treatment groups in one month and six months (P = 0.48 and P = 0.88, respectively). As for walking distance, the improvement process with both types of treatment during follow-up periods was significant (P < 0.001). However, after one and six months of treatment, the rate of improvement in patients' walking distance in the caudal epidural steroid injection plus ozone group was significantly higher than in the epidural steroid group (p = 0.026 and p = 0.017, respectively). Conclusions: In this study, the results of VAS and ODI outcomes showed that caudal epidural steroid injection combined with ozone has no advantage over caudal epidural steroid injection alone. Interestingly, our results demonstrated that the group receiving caudal epidural steroid injection plus ozone scored significantly higher on the walking distance index than the group receiving caudal epidural steroid alone. Trial Registration: IRCT IRCT20090704002117N2 (registration date: 07/08/2019). [ABSTRACT FROM AUTHOR]

Background: Several new ultrasound-guided superior cervical ganglia blocks (U-SCGBs) have been proposed to overcome the shortcomings of conventional superior cervical ganglia blocks; however, their clinical utility and practicality have not yet been demonstrated. The aim of this study was to evaluate the safety and utility of a new method of U-SCGB. Methods: We retrospectively collected data on patients who underwent U-SCGB for the treatment of headaches and orofacial pain at a single center. U-SCGB was performed by injecting 2–3 mL of 1% mepivacaine posterior to the internal carotid artery, just above the bifurcation. The Wilcoxon signed-rank test was used to compare pain scores. Numerical data are expressed as the mean ± standard error. Results: The total number of U-SCGB procedures was 43. All procedures were accompanied by Horner's sign. The numerical rating scale score for pain (possible scores, 0–10) was reduced predominantly from 7.0 ± 0.7 before treatment to 4.5 ± 0.7 at the follow-up (p = 0.014). Conclusion: U-SCGB was considered a clinically useful and accurate treatment for headaches and orofacial pain in this study. [ABSTRACT FROM AUTHOR]

Background: Intercostal nerve block (ICNB) is a very effective analgesic method. We aimed to explore the effect of preemptive analgesia with ultrasound-guided intercostal nerve block on postoperative analgesia in thoracoscopic surgery. Methods: 126 patients, aged 18–70 years, with American Society of Anesthesiologists (ASA) physical status I-II and scheduled for thoracoscopic pulmonary resection were enrolled in this study. 119 patients were left for final analysis. Patients were randomly allocated to group ICNB and group CONTROL. Patients in CONTROL group were administered sufentanil with patient-controlled analgesia device after operation In group ICNB, patients received ropivacaine ICNB prior to surgery and patient-controlled analgesia device after operation. The primary outcome is visual analog scale pain score (VAS) at rest at 0,4, 8,16,24,48,72 and 168 h postoperatively and they were compared. Surgical outcomes and rescue analgesia requirement were also recorded. Results: VAS scores were statistically significantly lower for ICNB group compared to control group at 0, 4, 8, 16, 24 and 48 h postoperatively. The duration of insertion of chest tube in ICBN group was shorter than that in control group, and the difference was statistically significant (4.69 ± 2.14 vs. 5.67 ± 2.86, P = 0.036). The postoperative hospital stay, incidence of nausea and vomiting and postoperative pulmonary infection rate in ICBN group were all lower than those in the control group, but there were no statistical differences. The frequency of rescue analgesia during 48 postoperative hours was different between the two groups (ICNB vs. Control; 9.83% vs. 31.03%, P = 0.004). Conclusions: For patients undergoing thoracoscopic surgery, ultrasound-guided ICNB is simple, safe, and effective for providing acute postoperative pain management during the early postoperative stage. Trial registration: Chinese clinical trials: chictr.org.cn, ChiCTR1900021017. Registred on 25/01/2019. [ABSTRACT FROM AUTHOR]

Background: Traumatic neuroma is a common sequela of peripheral nerve injury or amputation, which often leads to severe neuropathic pain. The present study investigated the effect of local lidocaine administration on preventing the formation of traumatic neuroma. Methods: Forty-eight male Sprague–Dawley rats were randomly assigned to two groups. The lidocaine group underwent sciatic nerve transection, followed by an injection of lidocaine (0.5%) around the proximal of a severed sciatic nerve under ultrasound-guidance 2–7 days after neurectomy. In the control group, rats received an injection of saline following neurectomy. The autotomy score, mechanical allodynia, thermal hyperalgesia, histological assessment, expression of neuroma, and pain-related markers were detected. Results: Lidocaine treatment reduced the autotomy score and attenuated mechanical allodynia and thermal hyperalgesia. The mRNA expression of α-SMA, NGF, TNF-α, and IL-1β all significantly decreased in the lidocaine group in comparison to those in the saline control group. The histological results showed nerve fibers, demyelination, and collagen hyperplasia in the proximal nerve stump in the saline control group, which were significantly inhibited in the lidocaine group. Conclusions: The present study demonstrated that local lidocaine administration could inhibit the formation of painful neuroma due to traumatic nerve injury. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical value of ultrasound guidance combined with C-arm guidance during selective semilunar ganglion radiofrequency thermocoagulation via the foramen ovale for trigeminal neuralgia. Methods This study enrolled 48 patients diagnosed with trigeminal neuralgia between January 2021 and December 2021 in the Department of Pain Management at Xuanwu Hospital. Patients were randomly and equally divided into a C-arm–only group and an ultrasound-combined-with–C-arm (ultrasound+C-arm) group, according to a random number table. After exclusions, 42 patients were analyzed. Of these, 21 patients underwent selective semilunar ganglion radiofrequency thermocoagulation via the foramen ovale guided by the C-arm alone, whereas 21 patients underwent the same procedure guided by ultrasound combined with C-arm. The number of punctures, the amount of time elapsed until the target area of the semilunar ganglion was punctured, the cumulative dose of radiation exposure, and puncture-related complications were recorded during the operation. Numerical rating scale scores and radiofrequency thermocoagulation–related complications were evaluated preoperatively and at 1 day, 3 days, 7 days, 1 month, and 3 months after surgery. Results The number of punctures, the amount of time elapsed until the target area of the semilunar ganglion was punctured, and the cumulative dose of radiation exposure were all lower in the ultrasound+C-arm group than in the C-arm–only group (all P  < 0.05). No significant differences were found in numerical rating scale scores and radiofrequency thermocoagulation–related complications between the two groups (P  > 0.05). No puncture-related complications occurred in either of the groups. Conclusion Ultrasound guidance combined with C-arm guidance could be safely used for puncturing the semilunar ganglion via the foramen ovale, with more efficiency and less radiation exposure than C-arm guidance alone. [ABSTRACT FROM AUTHOR]

Background: Biolaser is an emerging technology, which has attracted the attention of many surgeons and specialists in different medical fields. Objectives: This study aimed to evaluate the clinical effectiveness of ultrasound-guided biolaser radiation versus ozone therapy in reducing chronic pain in patients with knee osteoarthritis during a three-month follow-up. Patients and Methods: Sixty patients referring to pain clinic of Shohadaye-Tajrish and Akhtar hospitals in 2017, were included in this randomized single-blind clinical trial study. According to a randomized table of numbers, in Biolaser group (n = 30): 10 mL of normal saline + 5mLof lidocaine 1% + BioLaser + Physical Therapy and in the Ozone group (n = 30), received 10mLOzone (30 mic/mL) plus 5mLlidocaine 1% + BioLaser placebo + Physical Therapy received. The patients were evaluated for pain using visual analog scale (VAS) and knee function with Knee injury and Osteoarthritis Outcome Score (KOOS) questioner. The patients were followed up 4 & 12 weeks and reviewed at weeks 12 after the injection by an observer who was unaware of the groups (IRCT20111121008146N15). Results: Comparison of the mean age (56.8 ± 8.5 years in the biolaser group vs. 51.5 ± 5.4 years in the ozone therapy group; P = 0.721) and body mass index (31.1 ± 3.4 kg/m² in the biolaser group vs. 30.5 ± 2.6 kg/m² in the ozone therapy group; P = 0.214) did not indicate any significant differences between the two groups. The pain severity decreased significantly at different times in the biolaser and ozone therapy groups (P = 0.018). The knee pressure sensitivity score was 1.3 ± 0.5 in the biolaser group and 1.6 ± 0.4 in the ozone therapy group at 12 weeks post-treatment (P = 0.037). The knee circumference was also 35.6 ± 3.0 cm in the biolaser group and 39.7 ± 3.9 cm in the ozone therapy group at 12 weeks post-treatment (P = 0.032). The KOOS performance score was 46.9 ± 9.4 in the biolaser group and 49.3 ± 7.9 in the ozone therapy group (P = 0.187). Besides, the KOOS quality of life score was 10 ± 1.3 in the biolaser group and 10.4 ± 1.5 in the ozone therapy group (P = 0.586). Conclusion: Biolaser therapy under ultrasound guidance was found to be a safe, non-invasive, and effective method, which could improve chronic pain in knee osteoarthritis during a three-month follow-up. [ABSTRACT FROM AUTHOR]

Background: Rectus sheath block (RSB) and local anesthetic infiltration (LAI) are used for postoperative analgesia in pediatric laparoscopic inguinal hernia repair. However, whether the analgesic effect of RSB is superior to LAI remains unclear. The authors hypothesized that RSB would reduce opioid consumption in patients. Methods: Patients aged 3-14 years scheduled for laparoscopic inguinal hernia repair were randomly allocated to the RSB, local anesthetic infiltration high concentration (LAIHC), local anesthetic infiltration low concentration (LAILC), or control groups. Preoperatively, they received 0.4 ml/kg of 0.25% ropivacaine (RSB), 0.4 ml/kg of 0.25% ropivacaine (LAILC), or 0.2 ml/kg of 0.5% ropivacaine(LAIHC), and 0.2 ml/kg of normal saline (control). The primary outcome was equivalent morphine consumption. Results: The authors analyzed 136 patients (RSB, 33; LAIHC, 34; LAILC, 35; control, 34). Intraoperative morphine equivalent consumption was lower in the RSB group [0.115 (0.107-0.123)] than in the LAIHC [0.144 (0.137 -0.151)], LAILC [0.141 (0.134-0.149)], and control [0.160 (0.151-0.170)] groups (P <0.001). In the post-anesthesia care unit, morphine equivalent consumption differed between the RSB [0.018 (0.010-0.027)], LAIHC [0.038 (0.028-0.049)], LAILC [0.056 (0.044-0.067)], and control [0.074 (0.063-0.084)] groups (P< 0.001). The rescue morphine equivalent consumption did not differ significantly between the RSB [0.015 (0.007-0.023)] and LAIHC [0.019 (0.010-0.029)] groups, which were lower than that in the control group [0.037 (0.029-0.045)] (P =0.001). Conclusions: RSB can provide effective analgesia for pediatric laparoscopic inguinal hernia repair, with better effectiveness than that of LAI at the same dose. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate and clinically implement a deformable surface-based magnetic resonance imaging (MRI) to three-dimensional ultrasound (US) image registration algorithm for prostate brachytherapy (BT) with the aim to reduce operator dependence and facilitate dose escalation to an MRI-defined target. Our surface-based deformable image registration (DIR) algorithm first translates and scales to align the US- and MR-defined prostate surfaces, followed by deformation of the MR-defined prostate surface to match the US-defined prostate surface. The algorithm performance was assessed in a phantom using three deformation levels, followed by validation in three retrospective high-dose-rate BT clinical cases. For comparison, manual rigid registration and cognitive fusion by physician were also employed. Registration accuracy was assessed using the Dice similarity coefficient (DSC) and target registration error (TRE) for embedded spherical landmarks. The algorithm was then implemented intraoperatively in a prospective clinical case. In the phantom, our DIR algorithm demonstrated a mean DSC and TRE of 0.74 ± 0.08 and 0.94 ± 0.49 mm, respectively, significantly improving the performance compared to manual rigid registration with 0.64 ± 0.16 and 1.88 ± 1.24 mm, respectively. Clinical results demonstrated reduced variability compared to the current standard of cognitive fusion by physicians. We successfully validated a DIR algorithm allowing for translation of MR-defined target and organ-at-risk contours into the intraoperative environment. Prospective clinical implementation demonstrated the intraoperative feasibility of our algorithm, facilitating targeted biopsies and dose escalation to the MR-defined lesion. This method provides the potential to standardize the registration procedure between physicians, reducing operator dependence. [ABSTRACT FROM AUTHOR]

Abstract Objective To observe the clinical effect of botulinum toxin type A (BTA) injection into the salivary glands of the severe neurological patients with tracheotomy Methods Seven patients with severe neurological disorders after tracheotomy and obvious drooling symptoms were enrolled. BTA was injected into bilateral parotid glands and submandibular glands under the guidance of ultrasound. Unstimulated salivary flow rate (uSFR) and Drooling Severity and Frequency Scale (DSFS) were used to evaluate drooling before injection, 1 week, and 4 weeks after injection. We compared the extubation time, time of changing from balloon cannula to metal cannula, hospitalization time and incidence of recurrent pulmonary infection between these patients and other patients accepted conventional curation. Results (1) The drooling severity scale (DSFS‐S), the drooling frequency scale (DSFS‐F), the drooling frequency and severity scale total score (DSFS‐T) were significantly lower at 4 weeks after BTA injection compared to prior‐treatment (p

Ultrasound guidance in biliary interventions has become the standard tool to facilitate percutaneous biliary drainage as well as percutaneous gall bladder drainage. Monitoring of the needle tip whilst penetrating the tissue in real time using ultrasound allows precise manoeuvres and exact targeting without radiation exposure. Without the need for fluoroscopy, ultrasound-guided drainage procedures can be performed bedside as a sometimes life-saving procedure in patients with severe cholangitis/cholecystitis when they are critically ill in intensive care units and cannot be transported to a fluoroscopy suite. This article describes the current data background and guidelines and focuses on specific sonographic aspects of both the procedures of percutaneous biliary drainage and gallbladder drainage.

Untethered small‐scale helical devices (USHDs) have the potential to navigate blood vessels and treat vascular occlusive diseases. However, there are still many challenges in translating this method into clinical practice, both in terms of localization and wireless motion control. Herein, closed‐loop control characterization of the USHD against and along physiological fluid inside a blood vessel phantom at different penetration depths is shown. First the dynamic flow and ultrasound images noise affecting the measurement are modeled, and control system of the USHD based on bifurcation analysis of a 1D hydrodynamic model is designed. Then a region of attraction of a USHD driven by a permanent magnet robotic (PMR) system inside a blood vessel phantom around an equilibrium point is constructed. Further, the point‐to‐point closed‐loop control strategy is implemented based on the magnetic point‐dipole approximation and kinematic control of the PMR system and ultrasound feedback inside physiological fluid, blood vessel, and soft tissue. The frequency response of the USHD is characterized against and along the flowing streams of fetal bovine serum within different flow rates in the 6–20 mm s−1 range. The experimental results demonstrate the ability to navigate the USHD inside blood vessel phantoms with maximum position error of 1.99 ± 0.55 mm.

Background: Intrathecal injection of medications can be challenging in spinal muscular atrophy (SMA) patients with severe scoliosis or after spine surgery. Here we report our experience with real-time ultrasound (US)-guided intrathecal administration of nusinersen in patients with SMA. Methods: Seven patients (six children and one adult) with either spinal fusion or severe scoliosis were enrolled. We performed intrathecal injections of nusinersen under US guidance. The efficacy and safety of US-guided injection were explored. Results: Five patients had undergone spinal fusion, while the other two presented severe scoliosis. Success was achieved in 19/20 lumbar punctures (95%), 15 of which were performed through the near-spinous process approach. The intervertebral space with a designated channel was selected for the five postoperative patients, while the interspaces with the smallest rotation angle were chosen for the other two patients with severe scoliosis. In 89.5% (17/19) of the punctures, the number of insertions was no more than two. No major adverse events were observed. Conclusion: Given its safety and efficacy, real-time US guidance is recommended for SMA patients with spine surgery or severe scoliosis, and the near-spinous process view can be used as a interlaminar puncture approach for US guidance. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of erector spinal plane block (ESPB), serratus anterior plane block (SAPB) and thoracic paravertebral nerve block (TPVB) under ultrasound guidance on the early postoperative recovery of patients undergoing video-assisted thoracoscopic surgery (VATS). Methods A total of 90 patients aged 18-65 years old, American Association of Anesthesiologists (ASA) Grade I — II 1 who underwent elective VATS in the Affiliated Hospital of Guizhou Medical University from July 2020 to December 2021 were selected, and they were randomly assigned into three groups: ESPB (group E),SAPB (group S) and TPVB (group T),with 30 cases in each group. The use of opioid and vasoactive drugs during the operation, the QoR-40 score on the first day after operation, and the pain score [visual mode Quasi-scoring method (VAS)] at 2,4,8912 and 24 hours after operation, first pressing time of analgesic pump, analgesic recovery rate of Tramadol, patient satisfaction, puncture time of nerve block, occurrence puncture complications, the incidence of intraoperative hypotension during operation, the time of getting out of bed for the first time !and the postoperative hospitalization time in the three groups were observed and compared. Results The dosage of sufentanil in the three groups was similar. There was no significant difference in QoR-40 score on the first day after operation, VAS score at rest and cough at 2, 4,12, 24 h after operation, and patient satisfaction (P> 0. 05). The utilization rate of vasoactive substances in E and S groups was significantly lower than that in T group !and the puncture time of nerve block in E and S groups was significantly shorter than that in T group, while the incidence of hypotension in T group was significantly higher than that in E and S groups, and the differences were statistically significant (P<0. 05). There was no significant difference in the first compression time, effective compression times 'analgesic recovery rate of Tramadol, first ambulation time and postoperative hospitalization time among the three groups (P>0. 05). There were no complications such as pneumo-thorax, accidental injection into blood vessels and hematoma in all three groups. Conclusion Both ESPB and SAPB under ultrasound guidance all can accelerate the postoperative rehabilitation of VATS patients and pro-vide effective analgesia, and the operation of ESPB and SAPB under ultrasound guidance is simpler and faster than TPVB, and the incidence of intraoperative hypotension during operation is lower. [ABSTRACT FROM AUTHOR]

Difficult and failed airway management remains a significant cause of anesthesia-related morbidity and mortality. Failed airway management guidelines include performing a cricothyrotomy as a final step. Correct identification of the cricothyroid membrane (CTM) is essential for safe and accurate cricothyrotomy execution. Ten certified registered nurse anesthetists were assessed for ultrasound-guided (USG) needle cricothyrotomy competency following an online and hands-on education session using a human cadaver and then assessed 60 days later, without additional education or preparation. Both knowledge and confidence improved significantly when assessed immediately after education (P < .05) and were maintained when assessed 60 days later. Overall skill performance declined slightly from post-training although the decline was not statistically significant (P = .373). Overall needle placement time and distance from the CTM improved, despite improper transducer and image orientation by most participants. A one-hour hybrid educational program can significantly improve ultrasound and cricothyrotomy knowledge and confidence for 60 days. Transducer orientation may not be a significant contributor to performing proper USG needle cricothyrotomy. [ABSTRACT FROM AUTHOR]

Background: The aim of this randomised prospective study is to compare the outcomes of traditional open trigger digit release versus ultrasound-guided modified small needle-knife (SNK) percutaneous release in the treatment of trigger digits. Methods: Patients with grade 2 and above trigger digits were enrolled into the study and randomly assigned to traditional open surgery (OS) or ultrasound-guided modified SNK percutaneous release group. The patients were followed up for 7, 30 and 180 days after treatment and data with regard to visual analogue scale (VAS) score and Quinnell grading (QG) was collected and compared between the two groups. Results: A total of 72 patients were enrolled in the study with 30 in the OS group and 42 in the SNK group. VAS scores and QG of the two groups significantly decreased at 7 days and 30 days after treatment compared to before treatment, but there was no significant difference between the two groups. There was also no differences between the two groups at 180 days and between the values at 30 days and 180 days. Conclusions: The outcomes of ultrasound-guided SNK percutaneous release is similar to traditional OS. Level of Evidence: Level II (Therapeutic) [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of ultrasound and peripheral nerve stimulator guidance technique for supraclavicular block in upper limb surgery. Methods: A total of 100 patients who were admitted to our hospital and underwent upper limb surgery from May 2019 to April 2021 were recruited as research subjects. Patients were equally randomized into matched and lead groups according to the study protocol. The matched group used nerve stimulator to locate the superior brachial plexus block, the lead group used ultrasound and peripheral nerve stimulator to guide the upper brachial plexus block, and analyzed the completion time of clinical anesthesia and other related indicators. Results: There was no difference in general data between the two groups (P＞0.05), The completion time of anesthesia and the onset time of nerve block in the lead group were shorter than those in the matched group (P＜0.05), and the duration of nerve block in the lead group was longer than that in the matched group (P＜0.05), The excellent and good rate of anesthesia in the lead group was higher than that in the matched group (P＜0.05), and the moderate and poor rate of anesthesia in the lead group was lower than that in the matched group (P＜0.05), The overall incidence of complications in the lead group was lower than that in the matched group (P＜0.05), The sensory score, motor score, coping score and total score in the lead group were higher than those in the matched group (P＜0.05), The very satisfaction rate and total satisfaction rate in the lead group were higher than those in the matched group (P＜0.05), and the dissatisfaction rate in the lead group was lower than that in the matched group (P＜0.05), Conclusion: Compared with the nerve stimulator alone,ultrasound-guided assisted positioning of the supraclavicular brachial plexus block has the advantages of quick onset, complete block,and long duration. Ultrasound and peripheral nerve stimulator-guided techniques can improve the effectiveness of anesthesia, accuracy and safety, worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

Individuals with brachial plexus injury (BPI) require upper limb function restoration, but the treatment remains controversial. Vitamin B12 may aid in pain control and nerve regeneration. We present the technical aspects of ultrasound-guided perineural vitamin B12 injection for BPI. The demonstrative case is a 50-year-old man with BPI resulting from a traffic accident. Under ultrasound guidance, vitamin B12 was injected precisely into the brachial plexus compartment around the swollen neuroma of the C6 root. Motor and sensory functions of the left upper extremity improved over 6 months. Ultrasound-guided perineural vitamin B12 injection may be an efficient and personalized intervention in cases of post-ganglionic BPI that failed to improve in the first 3 months. [ABSTRACT FROM AUTHOR]

Background: Ultrasound (US)‐guided axillary vein (AV) catheterization has been considered as the preferred site of insertion to minimize catheter‐related infections. Given its difficulty of realization, internal jugular vein (IJV) access remains, thus, the first choice of catheter insertion site. This descriptive study was aimed to assess the success and complication rates of in‐plane short axis approach of IJV in the lower neck and the AV approach under US‐guidance. Methods: In a prospective randomized controlled open‐label pilot trial, all patients requiring central venous catheterization (CVC) in intensive care unit or operating room were randomly assigned to low IJV or AV groups. The primary objective was to estimate the overall success rate of both approaches. The secondary objectives were immediate complication rates, procedure durations, success rate after the first puncture, late complication rates (i.e., thrombosis, catheter colonization, and catheter‐related infections), and nurse satisfaction regarding insertion site dressings. Results: One hundred and seventy‐three out of two hundred and ten included patients were fully analyzed (90 and 83 in the IJV and AV approach groups, respectively). Overall success rates for IJV and AV sites were 96% (95% confidence interval (CI) [90–99]) and 89% (95% CI [81–94]) respectively. First puncture success rates were 90% and 80% respectively. The median overall procedure duration from US pre‐procedural screening to guidewire insertion was 8 and 10 min in IJV and AV groups. Overall immediate complications rates for IJV and AV sites were 11.6% and 14.6%, respectively. Incidence of catheter colonization were 7.9% and 6.8% and catheter‐related infection rate were 2.6% and 0%, respectively. Conclusion: In this pilot study, US‐guided low IJV and AV approaches are safe and efficient techniques for CVC insertion associated with high success and low complications rates. Duration for guidewire insertion seemed to be shorter in the short axis in‐plane IJV approach. It provides the basis for a future randomized trial comparing these two approaches. [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of artificial-intelligence perceptual learning when performing the ultrasound-guided popliteal sciatic block. Methods: This simulation-based randomized study enrolled residents who underwent ultrasound-guided sciatic nerve block training at the Department of Anesthesiology of Beijing Jishuitan Hospital between January 2022 and February 2022. Residents were randomly divided into a traditional teaching group and an AI teaching group. All residents attended the same nerve block theory courses, while those in the AI teaching group participated in training course using an AI-assisted nerve identification system based on a convolutional neural network instead of traditional training. Results: A total of 40 residents were included. The complication rates of paresthesia during puncture in the first month of clinical sciatic nerve block practice after training were significantly lower in the AI teaching group than in the traditional teaching group [11 (4.12%) vs. 36 (14.06%), P = 0.000093]. The rates of paresthesia/pain during injection were significantly lower in the AI teaching group than in the traditional teaching group [6 (2.25%) vs. 17 (6.64%), P = 0.025]. The Assessment Checklist for Ultrasound-Guided Regional Anesthesia (32 ± 3.8 vs. 29.4 ± 3.9, P = 0.001) and nerve block self-rating scores (7.53 ± 1.62 vs. 6.49 ± 1.85, P < 0.001) were significantly higher in the AI teaching group than in the traditional teaching group. There were no significant differences in the remaining indicators. Conclusion: The inclusion of an AI-assisted nerve identification system based on convolutional neural network as part of the training program for ultrasound-guided sciatic nerve block via the popliteal approach may reduce the incidence of nerve paresthesia and this might be related to improved perceptual learning. Clinical trial: CHiCTR2200055115, registered on 1/ January /2022. [ABSTRACT FROM AUTHOR]

Background: Limited data are available on the incidence of mechanical complications after ultrasound-guided central venous catheterisation. We aimed to determine the incidence of mechanical complications in hospitals where real-time ultrasound guidance is clinical practice for central venous access and to identify variables associated with mechanical complications.Methods: All central venous catheter insertions in patients ≥16 yr at four emergency care hospitals in Sweden from March 2, 2019 to December 31, 2020 were eligible for inclusion. Every insertion was monitored for complete documentation and occurrence of mechanical complications within 24 h after catheterisation. Multivariable logistic regression analyses were used to determine associations between predefined variables and mechanical complications.Results: In total, 12 667 catheter insertions in 8586 patients were included. The incidence (95% confidence interval [CI]) of mechanical complications was 7.7% (7.3-8.2%), of which 0.4% (0.3-0.5%) were major complications. The multivariable analyses showed that patient BMI <20 kg m-2 (odds ratio 2.69 [95% CI: 1.17-5.62]), male operator gender (3.33 [1.60-7.38]), limited operator experience (3.11 [1.64-5.77]), and increasing number of skin punctures (2.18 [1.59-2.88]) were associated with major mechanical complication. Subclavian vein catheterisation was associated with pneumothorax (5.91 [2.13-17.26]).Conclusions: The incidence of major mechanical complications is low in hospitals where real-time ultrasound guidance is the standard of care for central venous access. Several variables independently associated with mechanical complications can be used for risk stratification before catheterisation procedures, which might further reduce complication rates.Clinical Trial Registration: NCT03782324. [ABSTRACT FROM AUTHOR]

Cardiac radioablation is a promising treatment for cardiac arrhythmias, but accurate dose delivery can be affected by heart motion. For this reason, real-time cardiac motion monitoring during radioablation is of paramount importance. Real-time ultrasound (US) guidance can be a solution. The US-guided cardiac radioablation workflow can be simplified by the simultaneous US and planning computed tomography (CT) acquisition, which can result in US transducer-induced metal artifacts on the planning CT scans. To reduce the impact of these artifacts, a new metal artifact reduction (MAR) algorithm (named: Combined Clustered Scan-based MAR [CCS-MAR]) has been developed and compared with iMAR (Siemens), O-MAR (Philips) and MDT (ReVision Radiology) algorithms. CCS-MAR is a fully automated sinogram inpainting-based MAR algorithm, which uses a two-stage correction process based on a normalized MAR method. The second stage aims to correct errors remaining from the first stage to create an artifact-free combined clustered scan for the process of metal artifact reduction. To evaluate the robustness of CCS-MAR, conventional CT scans and/or dual-energy CT scans from three anthropomorphic phantoms and transducers with different sizes were used. The performance of CCS-MAR for metal artifact reduction was compared with other algorithms through visual comparison, image quality metrics analysis, and HU value restoration evaluation. The results of this study show that CCS-MAR effectively reduced the US transducer-induced metal artifacts and that it improved HU value accuracy more or comparably to other MAR algorithms. These promising results justify future research into US transducer-induced metal artifact reduction for the US-guided cardiac radioablation purposes. [ABSTRACT FROM AUTHOR]

We aimed to compare intraoperative sedation and postoperative analgesic effects of brachial plexus block using bupivacaine-dexmedetomidine mixture (BD) versus bupivacaine alone (B) in upper extremity bone surgeries. We conducted a randomized comparative study at Can Tho City, Vietnam. We recruited patients aged 15 to 75 years, ASA (American Society of Anesthesiology) I-III grade, indicating bone surgeries of arm or forearm with supraclavicular brachial plexus block by ultrasound guidance. One hundred eight included patients were randomly divided into two groups: the BD group (54 patients) received a 30 ml mixture of 0.25% bupivacaine and 100 mcg dexmedetomidine, and the B group (54 patients) received 30 ml of 0.25% bupivacaine. The BD group had a sedative OAA/S score (Observer Assessment of Alertness/Sedation Scale) of level 4, accounting for 87% more than group B 37%, and an OAA/S score of level 3 in the BD group with 5 cases (9.3%) compared with 9 cases (16.7%) in group B, statistically significant difference with p

Abstract Background Carpal tunnel syndrome (CTS) is caused by compression of the median nerve at the wrist level and the most frequent entrapment neuropathy in the upper limb. It can be treated with surgical or non-surgical methods. When nonsurgical treatment is indicated, a local corticosteroid injection into the carpal tunnel can be used to reduce pain and tingling sensation. To assess the clinical outcomes and effectiveness of patient satisfaction following ultrasound-guided steroid injection for the treatment of carpal tunnel syndrome. Results The study comprises 44 female (73%) and 16 (27%) male patients, with a mean age of 57 (27–84) years. Thirty-one patients were left-handed and 29 right-handed. Twenty-six (43%) injections were performed on the right side, 8 (13%) on the left, and 26 were bilateral. Fifty-six hands of thirty-seven (70%) patients reported significant improvement symptoms, five (8%) had temporary improvement with recurrence, seventeen patients (28%) failed to improve, and one patient’s symptoms have resolved before intervention. Among temporary responders and nonresponders, two were referred to the neurologist for further evaluation. Out of twenty patients, fourteen patients (23%) had surgical decompression of carpal tunnel with complete resolution of symptoms, four patients had opted for repeat injections, and two patients refused any further intervention. Conclusions The use of ultrasound-guided injection for the treatment of mild to moderate carpal tunnel syndrome is a practical procedure before offering surgical treatment. It is also appropriate for the patient with significant medical problems or not willing to undergo surgical intervention. Its ultrasound guide reduces injection-related complications, improves patient satisfaction, is cost-effective, and improves patient compliance.

ABSTRACT In this article the most relevant methods of subclavian vein catheterization were considered in order to find the optimal technique that can be used in routine clinical practice by pediatric intensive care physicians.OBJECTIVE To compare the efficiency and safety of subclavian vein catheterization by supraclavicular access under ultrasound control and subclavian access by anatomical landmarks in children.RESULTS The number of attempts for successful catheterization was statistically lower in ultrasound-control group compared to the anatomical landmarks group (1.2±0.4 vs. 2.6±1.3, p

Introduction. Occipital neuralgia (ON) is a well-known cause of headache that affecting the posterior head at the occipital nerve(s) distribution. It is a multiple-factor clinical condition resulting from the pathology of the greater, lesser or third occipital nerve. Interventional therapy, such as occipital nerve block (ONB), is one of the various modalities that could be normally considered when the conservative wasn’t satisfying. Besides as effective treatment, ONB also used as an important diagnostic procedure for occipital neuralgia. Content. Currently, there is no a complete consensus among practitioners regarding the optimal therapy for occipital neuralgia although many modalities offered. ONB traditionally performed with blinded approach relying on anatomic landmarks create the higher risks of injection in the occipital artery and/or block failure. Therefore, ONB with ultrasound guidance becomes solution to improve the safety and efficacy of therapy especially in occipital neuralgia cases. Conclusion. Occipital nerve block with ultrasound guidance is recommended as primary interventional therapy for occipital neuralgia cases.

Man Feng,1 Lulu Wang,2 Jing Sun,2 Zheping Chen,2 Jia Fu,3 Dongyi Liu,3 Rumeng Zhang,3 Youqin Li,2 Yan Zhang,2 He Zhang,3 Weiquan Zhang,4 Chang Feng3 1Department of Pathology, Affiliated Hospital of Shandong Academy of Medical Sciences, The third Affiliated Hospital of Shandong First Medical University, Jinan, 250000, People’s Republic of China; 2Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China; 3Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of China; 4Department of Thoracic Surgery, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, People’s Republic of ChinaCorrespondence: Chang Feng, Department of Anaesthesiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247 Bei Yuan Street, Jinan, 250033, People’s Republic of China, Tel +86 17660085521, Email fengc2016@126.comPurpose: To investigate the effects of ultrasound-guided thoracic paravertebral block combined with general anaesthesia or general anaesthesia alone for thoracoscopic lung adenocarcinoma surgery, and to provide new thoughts for improving the clinical outcomes.Methods: This was a retrospective study. Data were retrieved for 195 patients with lung adenocarcinoma undergoing elective radical lobectomy via video-assisted thoracoscopy between January 2018 and August 2019 in The Second Hospital of Shandong University, including 86 patients who received thoracic paravertebral block (TPVB) combined with general anaesthesia (group TG), and 109 patients who received general anaesthesia alone (group GA). All patients were given self-controlled intravenous analgesia pump for 48 h after surgery. The primary outcome was the recurrence-free survival 2 years postoperatively (the time between surgery and the earliest date of recurrence, metastasis or lung cancer-cause death). The secondary outcomes included the average numeric rating scale (NRS) scores within 48 h postoperatively, the first time of postoperative ambulation, duration of chest tube drainage, length of postoperative hospitalization, perioperative opioid consumption and the postoperative side effects.Results: There were no statistical differences in the recurrence-free survival 2 years postoperatively between groups (Multivariate hazard ratio 0.706, 95% CI 0.126– 3.941, P=0.691). The average NRS scores within 48 h postoperatively were significantly lower in group TG (P< 0.05). The first time of postoperative ambulation, duration of chest tube drainage, and length of postoperative hospitalization in group TG were significantly reduced (P< 0.05). Opioid consumption was significantly decreased in group TG (P< 0.01). Finally, the incidence of postoperative nausea and vomiting (PONV) was significantly lower in group TG (P< 0.05).Conclusion: TPVB for thoracoscopic lung adenocarcinoma surgery did not improve the recurrence-free survival 2 years postoperatively compared with general anaesthesia alone, but it significantly enhanced the postoperative analgesia effect, reduced opioid consumption as well as side effects, and accelerated postoperative early recovery.Clinical Trial Registration Number: The Chinese Clinical Trial Registry (ChiCTR-2100050454).Keywords: lung adenocarcinoma, prognosis, video-assisted thoracoscopic surgery, thoracic paravertebral block, ultrasound guidance

Abstract Objective To observe whether ultrasound-guided stellate ganglion block (SGB) can effectively relieve migraine pain and improve the quality of migraine patients’ life. Methods 81 patients with migraines were enrolled in this study. The patients received SGB with 6 ml of 0.15% ropivacaine once every week for four times. Migraine was assessed with the Migraine Disability Assessment Scale (MIDAS) at baseline and three-months follow-up (Tm). The numerical rating scale (NRS) score at baseline, one day after treatment (Td) and Tm, the frequency of analgesic use in 3 months and the side effects were also recorded at the same time. Results The NRS score of migraine subjects decreased significantly from 7.0 (2.0) to 3.0 (1.0) at Td and 2.0 (2.0) at Tm (vs baseline, P