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Background: Intravenous therapies are essential for hospitalised patients. The rapid dissemination of portable ultrasound machines has eased ultrasound‐guided intravenous access and facilitated increased use of long peripheral venous catheters (LPCs). This study aimed to evaluate the clinical performance and complications of LPCs. Methods: Retrospective, observational single‐site study. Data from all consecutively inserted LPCs during a period of 18 months was evaluated. The primary endpoint was the all‐cause incidence rate of catheter removal. Secondary endpoints included specific reasons for the catheter removal and the associations between predefined characteristics of the patients, the infusions and the catheters with catheter failure. Results: During the period, 751 PVCs were inserted in 457 patients. The reasons for catheter removal were recorded in 563 cases. The overall incidence rate of catheter removal was 95.8/1000 catheter days (95% CI 88.4–103.8). The median dwell time was 8 days (IQR 5–14), and the total dwell time was 6136 days. Catheter failure occurred in 283 (50.3%) cases, of which the most common cause was phlebitis (n = 101, 17.9%). In multivariable analyses, the use of the cephalic vein was significantly associated with both all‐cause catheter failure (p <.001) and catheter failure due to phlebitis (p <.001). In multivariable analyses, vancomycin infusion was not significantly associated with all‐cause catheter failure (HR 1.15 (0.55–2.42), p =.71) or catheter failure due to phlebitis (HR 1.49 (0.49–4.53), p =.49). Conclusion: The overall incidence rate of catheter removal was 95.8/1000 catheter days, and the most common causes of catheter failure were phlebitis, infiltration and unintended catheter removal. The use of the cephalic vein was significantly associated with catheter failure in multivariable analyses. We did not find an association between vancomycin infusion and catheter failure in multivariable analyses. [ABSTRACT FROM AUTHOR]

Objective To explore the treatment effects and safety of transthoracic ultrasound-guided closure combined with percutaneous coronary intervention (PCI) in patients with coronary artery disease and patent foramen ovale (PFO). Methods A retrospective analysis was conducted on the clinical data of 110 patients who underwent PFO closure combined with PCI from February 2021 to March 2024. Among them, 50 patients underwent X-ray-guided PFO closure (X-ray group), and 60 patients underwent transthoracic echocardiography (TTE) -guided PFO closure (TTE group). The study compared perioperative cardiac function indices, shunt status, complication rates, and adverse events during follow-up, including bleeding, paradoxical embolism, myocardial infarction, sudden death, and stroke.Results There were no significant differences in closure time, PCI time, and hospital stay between the TTE and X-ray groups (P＞0.05). Post-treatment, cardiac function indices improved in both groups compared to pre-treatment (P＜0.05), with no significant differences between groups (P＞0.05). Shunt status also improved post-treatment (P＜0.05), but differences between groups were not statistically significant (P＞0.05). The complication and adverse event rates were similar between the two groups (P＞0.05). The Log-rank test indicated no significant difference in clinical event-free survival between TTE-guided and X-ray-guided PFO closure combined with PCI (HR=0.783, 95% CI: 0.324-1.895, P=0.582). Conclusion For patients with PFO and coronary artery disease, TTE-guided PFO closure combined with PCI is as safe and feasible as X-ray-guided methods. TTE procedures can help reduce radiation exposure in clinical settings while maintaining good safety. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Catheter malposition after subclavian venous catheterization (SVC) is not uncommon and can lead to serious complications. This study hypothesized that the left access is superior to the right access in terms of catheter malposition after ultrasound-guided infraclavicular SVC due to the asymmetry of the bilateral brachiocephalic veins. DESIGN: Parallel-armed randomized controlled trial. SETTING: A tertiary referral hospital in Korea. PATIENTS: Patients 20-79 years old who were scheduled to undergo SVC under general anesthesia. INTERVENTIONS: Patients were randomly assigned to either the left (n = 224) or right (n = 225) SVC group. The primary outcome measure was the overall catheter malposition rate. The secondary outcome measures included catheter malposition rates into the ipsilateral internal jugular and contralateral brachiocephalic veins, other catheterization-related complications, and catheterization performance. MEASUREMENTS AND MAIN RESULTS: The catheter malposition rate was lower (10 [4.5%] vs. 31 [13.8%], p = 0.001), especially in the ipsilateral internal jugular vein (9 [4.0%] vs. 24 [10.7%], p = 0.007), in the left SVC group than in the right SVC group. In the left SVC group, catheterization success rates on the first pass (88 [39.3%] vs. 65 [28.9%], p = 0.020) and first-catheterization attempt (198 [88.4%] vs. 181 [80.4%], p = 0.020) were higher whereas times for vein visualization (30 s [18-50] vs. 20 s [13-38], p < 0.001) and total catheterization (134 s [113-182] vs. 132 s [103-170], p = 0.034) were longer. There were no significant differences in other catheterization performance and catheterization-related complications between the two groups. CONCLUSIONS: These findings strengthen the rationale for choosing the left access over the right access for ultrasound-guided infraclavicular SVC. [ABSTRACT FROM AUTHOR]

Objectives: To assess needle placement accuracy in the rectus abdominis (RA) muscle during dry needling (DN) without entering the peritoneum. Methods: Two physical therapists performed DN on a cadaver, making 10 attempts each to needle the RA without entering the peritoneum. Techniques followed two common DN approaches. Ultrasound verified needle depth and safety. Results: Seventy percent of attempts were recorded as safe needle placement, while 30% were unsafe. Accurate RA needle placement without peritoneal entry occurred in 55% of attempts. Discussion/Conclusion: Inadvertent peritoneal needle placement during RA DN poses risks regardless of experience. Ultrasound guidance may enhance safety and precision in clinical practice. [ABSTRACT FROM AUTHOR]

Background Multiple hippocampal transection (MHT) is a surgical technique used for the treatment of drug-resistant mesial temporal lobe epilepsy in situations where standard procedures would pose a high risk for memory deterioration. During MHT, the longitudinal fibers of the hippocampus, implicated in epilepsy spreading, are interrupted, while the transverse memory circuits are spared. The extent of MHT is governed by intraoperative electrocorticography; abolition of epileptic discharges serves as an end point to terminate the transection. In other words, the aim of MHT is not the anatomical completeness of hippocampal transection. In contrast, we hypothesize that only the complete transection of hippocampal cross-section is needed to durably terminate epilepsy, avoiding possible postoperative reorganization of longitudinal pathways. Here, we report an anatomical study designed to evaluate the feasibility of complete transection of hippocampus with the aid of ultrasound neuronavigation and we propose new instruments to reach this goal. Methods Five cadaveric brains were analyzed in this study. MHT was performed on both sides of each brain either with or without ultrasound neuronavigation. The percentage of transected cross-section of the hippocampus was measured using magnetic resonance imaging (MRI) and both sides were compared. Results The ultrasound-guided MHTs were more likely to achieve complete hippocampal transection compared with the nonnavigated MHT transection (73 vs 58%; p < 0.01). Our study also allowed us to propose specialized transectors to minimize invasivity of this procedure. Conclusion Completeness of MHT can be better reached with the aid of an ultrasound neuronavigation system; modified instruments for this procedure were also designed. [ABSTRACT FROM AUTHOR]

Jinyu Lai,1 Yijun Wu,2 Yong Xiang,1 Yun Wang3 1Department of Pain, Taihe Hospital, Hubei University of Medicine, Hubei, People’s Republic of China; 2Department of Radiology, Taihe Hospital, Hubei University of Medicine, Hubei, People’s Republic of China; 3Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of ChinaCorrespondence: Yun Wang, Department of Anesthesiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People’s Republic of China, Tel +86-10-13521611825, Email wangyun129@ccmu.edu.cn Yong Xiang, Department of Pain,Taihe Hospital, Hubei University of Medicine, Hubei, 442000, People’s Republic of China, Tel +86-719-13972451941, Email 411734468@qq.comPurpose: Currently, minimally invasive intervention surgery for cervical spondylotic radiculopathy mostly involves the use of cervical dorsal root ganglion (DRG) block or radiofrequency modulation therapy. Here, we proposed a novel transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment.Patients and Methods: A retrospective analysis of the clinical data of 30 patients with cervical spondylotic radiculopathy admitted to the Pain Department of Taihe Hospital Affiliated with Hubei Medical University from January 2021 to March 2024 was performed. During surgery, motor electrical stimulation was used to induce movement in the nerve-innervated area, and the relationship between the puncture needle tip and the cervical DRG position was verified using a C-arm X-ray machine. The numerical rating scale (NRS) was used for preoperative and postoperative pain assessment, clinical treatment effectiveness was evaluated, surgical duration and the associated complications were also recorded.Results: Thirty patients exhibited clear cervical DRG images under ultrasound guidance, and the punctures were successful in all patients. Motor electrical stimulation induced movement in the corresponding nerve innervation area in the range of 0.3– 0.8 mv in all patients. No serious complications occurred during the procedure.Conclusion: The transverse ultrasound-guided approach for puncturing the cervical dorsal root ganglion at the level of joint column for radiofrequency treatment is effective, convenient, and safe.Keywords: ultrasound guidance, neck DRG, cervical spondylotic radiculopathy, pulse RF

Objective To observe the clinical efficacy of ultrasound-guided autologous platelet- rich plasma (PRP) injection for the treatment of common peroneal nerve compression syndrome, and to provide reference for the treatment of peripheral nerve compression diseases. Methods A patient with common peroneal nerve compression syndrome was treated with ultrasound-guided injection of autologous PRP for nerve water separation. The efficacy of PRP injection treatment on common peroneal nerve compression syndrome was evaluated by observing the patient′s symptoms, electrophysiological and imaging manifestations. Results After systematic injection therapy, the patient′s symptoms, signs and electromyography showed significant improvement, and there were no significant adverse reactions after 3 months of follow-up. Conclusion Ultrasound guided PRP injection therapy improves neurological dysfunction in common peroneal nerve compression syndrome.

BACKGROUND: Needle-knife release of the ligamentum flavum can effectively improve symptoms in patients with lumbar degeneration, and ultrasound guidance can increase the precision of needle-knife release; however, the specific effects of needle-knife release of the ligamentum flavum on the degenerated intervertebral discs and the possible mechanisms remain to be clarified. OBJECTIVE: To investigate the effect of ultrasound-guided needle-knife release of the ligamentum flavum. METHODS: Twenty-four New Zealand rabbits were randomized into control (n=6) and model (n=18) groups. A rabbit model of lumbar disc degeneration model was established in the model group by cutting the supraspinous and interspinous ligaments of the L5/6 and L6/7 segments to maintain a standing posture and apply axial load to the lumbar spine. After successful modeling, the model rabbits were subdivided into a control group, a model group, an ultrasonic needleknife group, and a sham needle-knife group according to a random number table method, with six animals in each group. The ultrasonic needle-knife group underwent ultrasound-guided needle-knife release of the right yellow ligament of L7/S1, once every week, for a total of four times. The needle-knife approach in the sham needle-knife group was the same as that in the ultrasound needle-knife group, but the ligamentum flavum was not released. At 30 days after the intervention, MRI was used to observe the changes in the signal intensity of the nucleus pulposus within the L7/S1 segment. Hematoxylin-eosin staining was used to observe the morphological changes of the L7/S1 segment. Immunohisto-chemical staining was used to detect the expression of type I and II collagen in the nucleus pulposus of the L7/S1 segment. RT-PCR and western blot were used to detect the expression of integrin α5 and β1, p38, and nuclear factor κB in the L7/S1 segment. RESULTS AND CONCLUSION: MRI findings indicated that the nucleus pulposus of the intervertebral disc of rabbits in the model group was gray-black in color, and the gray value of the nucleus pulposus was significantly lower than that of the control group (P < 0.01). The brightness of the nucleus pulposus of the intervertebral disc of the rabbits in the ultrasonic needle-knife group was elevated compared with that of the model group, and the gray value of the nucleus pulposus was higher than that of the model group (P < 0.01). Results from hematoxylin-eosin staining showed that in the model group, the shape of the nucleus pulposus was irregular, the number of nucleus pulposus cells was reduced, the extracellular matrix was compressed, the fibrous ring was ruptured, the structure and boundary of the end plate were unclear, and the chondrocytes were arranged disorderly. Compared with the model group, the ultrasonic needle-knife group showed an increase in the number of the nucleus pulposus, an improvement in the rupture of the fibrous ring, and more regular arrangement of cartilage endplate cells. Results from immunohisto-chemical staining showed an increase in positive expression of type I collagen (P < 0.01) and a decrease in positive expression of type II collagen in the nucleus pulposus of the model group compared with the control group as well as a decrease in positive expression of type I collagen and an increase in positive expression of type II collagen in the nucleus pulposus of the ultrasonic needle-knife group compared with the model group (P < 0.01). RT-PCR and western blot assays showed that the mRNA and protein expression of integrin α5, integrin β1, p38, and nuclear factor κB in the intervertebral discs of rabbits in the model group were increased compared with that in the control group (P < 0.01); the mRNA and protein expression of integrin α5, integrin β1, p38, and nuclear factor κB in the intervertebral discs of rabbits in the ultrasonic needle-knife group was decreased compared with that in the model group (P < 0.01). To conclude, ultrasound-guided needle-knife release of the ligamentum flavum can improve the degree of lumbar disc degeneration in rabbits, which may be related to the inhibition of p38 and nuclear factor-κB expression by modulating integrin α5 and β1 expression. [ABSTRACT FROM AUTHOR]

Introduction: Supraclavicular approaches serve as a common method for administering regional anesthesia in upper limb procedures. In improving the impact with a length of pain relief, medical professionals frequently include additional substances such as dexmedetomidine, buprenorphine, dexamethasone, clonidine, sodium bicarbonate, and tramadol alongside local anesthetics. The intent of this study was to evaluate its impact of incorporating buprenorphine and dexmedetomidine into ropivacaine 0.5%. Materials and Methods: The trial of 90 patients between the ages of 18 and 60, who were identified as American Society of Anesthesiologists Grade 1 and 2, and scheduled upper limb surgery using the supraclavicular approach, were included. They were assigned into distinct groups, each of the groups consisting of thirty individuals. Group R was administered anesthesia consisting of 25 ml of ropivacaine 0.5% along with 1 ml of saline. Group B was administered anesthetics containing ropivacaine 0.5% and buprenorphine, which was diluted in saline. Group D was administered a solution containing ropivacaine 0.5% and dexmedetomidine, which was diluted in saline. Results: Group D had an earlier sensory blockade onset (8.25 min) compared to Group B (9.64 min) and Group R (12.89 min). Group D demonstrated a notably quicker motor blockade onset (9.21 min) in contrast to Group B (12.07 min) and Group R (15.03 min). In contrast with the other groups, Group D exhibited a more longer time frame of both sensory and motor blockades and also an extended period of anesthesia after the surgery. Conclusion: Dexmedetomidine was a more effective adjuvant over buprenorphine in the brachial plexus blocks. This resulted in significantly lower postoperative pain scores at 407.67 min and 612.32 min for the plain ropivacaine and buprenorphine groups, respectively.

Abstract Background To explore a novel ultrasound (US) modality for lumbar transforaminal epidural injections (TFEIs) in patients with low back pain (LBP) and L5 radicular pain combined with high iliac crest (HIC). Methods One-hundred and forty-one patients were retrospectively stratified into two groups based on the treatment they received: novel group, receiving US-guided and fluoroscopy (FL)-controlled TFEIs using a sagittal oblique approach between the superior articular process of L5 and S1, and control group, receiving US-guided TFEIs with conventional transverse approach combined with FL confirmation. Accuracy of contrast dispersing into lumbar epidural space was set as the primary endpoint. Radiation dosages, procedure time, numeric rating scale (NRS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, adverse events, and rescue analgesic requirement were also recorded. The generalized liner mixed model (GLMMs) was employed to compare the repeatedly measured variables between groups, taking individual confounding factors as covariance. Results The accuracy of TFEIs was 92.8% and 65.2% in novel and control group, with a significant difference of 26.7% (95% CI: 15.4%, 39.8%) between two modalities (p

Background: Breast cancer remains the most commonly diagnosed cancer in women. Breast-conserving surgery (BCS) is the standard approach for small low-risk tumors. If the efficacy of cryoablation is demonstrated, it could provide a minimally invasive alternative to surgery. Purpose: To determine the success of ultrasound-guided cryoablation in achieving the absence of Residual Invasive Cancer (RIC) for patients with ER + /HER2- tumors ≤ 2cm and sonographically negative axillary nodes. Materials and Methods: This prospective study was carried out from April 2021 to June 2023, and involved 60 preoperative cryoablation procedures on ultrasound-visible, node-negative (cN0) infiltrating ductal carcinomas (IDC). Standard diagnostic imaging included mammography and tomosynthesis, supplemented by ultrasound-guided biopsy. MRI was performed in patients with associated intraductal carcinoma (DCIS) and an invasive component on core needle biopsy (18 out of 22 cases). All tumors were tagged with ferromagnetic seeds. A triple-phase protocol (freezing–thawing-freezing) with Argon was used, with an average procedure duration of 40 min. A logistic regression model was applied to determine significant correlation between RIC and the study variables. Results: Fifty-nine women (mean age 63 ± 8 years) with sixty low-risk unifocal IDC underwent cryoablation prior to surgery. Pathological examination of lumpectomy specimens post-cryoablation revealed RIC in only one of 38 patients with pure IDC and in 4 of 22 mixed IDC/DCIS cases. All treated tumors had clear surgical margins, with no significant procedural complications. Conclusions: Cryoablation was effective in eradicating 97% of pure infiltrating ER + /HER2-tumors ≤ 2cm, demonstrating its potential as a surgical alternative in selected patients. [ABSTRACT FROM AUTHOR]

Background: Advances in endovascular interventions have made endovascular approaches the first option for treating peripheral arterial diseases. Although radial artery access is commonly used for coronary procedures, the common femoral artery remains the most frequent site for endovascular treatments due to better ergonomics and proven technical success. Meanwhile, data on using upper extremity access via the brachial artery during complex endovascular aortic interventions are lacking. This study aimed to compare the incidence of access site complications between ultrasound-guided percutaneous brachial access (UPA) and open surgical incisional brachial access (OSA) in the management of peripheral arterial diseases. Methods: Patients who underwent treatment for peripheral arterial and aortic disease using brachial access from 2019 to 2023 were included in this study. The primary endpoint was the complication rate at the access site 30 days postoperatively. Access-related complications included bleeding requiring re-exploration, acute upper limb ischemia, thrombosis, pseudoaneurysm, arteriovenous fistula, and nerve injury associated with the brachial access. Results: Brachial access was performed on 485 patients (UPA, n = 320; OSA, n = 165). The mean operation time was 164.5 ± 45.4 min for the percutaneous procedure and 289.2 ± 79.4 min for the cutdown procedure (p = 0.003). Postprocedural hematoma occurred in 15 patients in the UPA group and 2 patients in the OSA group (p = 0.004). Thromboembolic events were observed in 9 patients in the percutaneous group and 3 patients in the OSA group. Reoperation was required for 23 patients in the percutaneous group and 8 patients in the cutdown group. Conclusions: The findings indicate that patients undergoing endovascular arterial interventions have a higher rate of brachial access complications in the UPA group compared to the OSA group. [ABSTRACT FROM AUTHOR]

Background: To explore a novel ultrasound (US) modality for lumbar transforaminal epidural injections (TFEIs) in patients with low back pain (LBP) and L5 radicular pain combined with high iliac crest (HIC). Methods: One-hundred and forty-one patients were retrospectively stratified into two groups based on the treatment they received: novel group, receiving US-guided and fluoroscopy (FL)-controlled TFEIs using a sagittal oblique approach between the superior articular process of L5 and S1, and control group, receiving US-guided TFEIs with conventional transverse approach combined with FL confirmation. Accuracy of contrast dispersing into lumbar epidural space was set as the primary endpoint. Radiation dosages, procedure time, numeric rating scale (NRS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, adverse events, and rescue analgesic requirement were also recorded. The generalized liner mixed model (GLMMs) was employed to compare the repeatedly measured variables between groups, taking individual confounding factors as covariance. Results: The accuracy of TFEIs was 92.8% and 65.2% in novel and control group, with a significant difference of 26.7% (95% CI: 15.4%, 39.8%) between two modalities (p < 0.001). Significant pain relief was observed in novel group as opposed to control group after one injection. Procedure time in novel group (8.4 ± 1.6 min) was shorter than control group (15.8 ± 3.5 min) (p < 0.001) with less radiation dosage (3047 ± 5670 vs. 8808 ± 1039 μGy/m2, p < 0.001). Significantly, lower incidence of L5 paresthesia occurred in novel group. Statistical differences of NRS scores between the novel and control group were reached at 1 week after procedure (1 (IQR: − 1–3) vs. 3 (IQR: − 1–7), p = 0.006), while not reached at both 1- (1 (IQR: 0–2) vs. 1 (IQR: − 1–3), p = 0.086) or 3-month follow-up (0 (IQR: − 1–1) vs. 1 (IQR: 0–2), p = 0.094). Both groups showed similar functional improvement (F = 0.103, p = 0.749) during follow-up. Conclusions: The novel sonographic technique provided superior accuracy needle placement and better pain-relieving effect through one injection as compared to the routine transverse approach. Consequently, in situations where the HIC imposed limitations for TFEIs performance on L5, the novel technique should be recommended to consider increasing accurate puncture, minimizing radiation exposure, consuming procedure time, and reducing the risk of neuraxial injury. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy and safety of ultrasound-guided pulsed radiofrequency (PRF) targeting the supraorbital nerve for treating the ophthalmic branch of postherpetic trigeminal neuralgia. Methods: A retrospective cohort study was conducted involving patients who presented at the Department of Pain, Affiliated Hospital of Southwest Medical University from January 2015 to January 2022. The patients were diagnosed with the first branch of postherpetic trigeminal neuralgia. In total, 63 patients were included based on the inclusion and exclusion criteria. The patients were divided into the following two groups based on the treatment method used: the nerve block (NB) group (n = 32) and the PRF + NB group (radiofrequency group, n = 31). The visual analog scale (VAS) score, Pittsburgh Sleep Quality Index (PSQI) score, and pregabalin dose were compared between the two groups before treatment, 1 week after the procedure, and 1, 3, and 6 months post-procedure, and the complications, such as local infection, local hematoma, and decreased visual acuity, were monitored post-treatment. Results: No significant difference was found in terms of pretreatment age, sex, course of disease, preoperative VAS score, preoperative PSQI score, and preoperative pregabalin dose between the two groups (P > 0.05). The postoperative VAS score, PSQI score, and pregabalin dose were significantly decreased in both groups. Furthermore, significant differences were found between the two groups at each preoperative and postoperative time point (P < 0.05). The VAS score was lower in the radiofrequency group than in the NB group at 1, 3, and 6 months, and the difference was statistically significant (P < 0.05). The PSQI score was lower in the radiofrequency group than in the NB group at 1 week, 1, 3, and 6 months post-procedure, and the difference was statistically significant (P < 0.05). The dose of pregabalin was lower in the radiofrequency group than in the NB group at 1 week, 1, 3, and 6 months post-procedure, and the difference was statistically significant at 3 and 6 months (P < 0.05). After 6 months of treatment, the excellent rate of VAS score in the radiofrequency group was 70.96%, and the overall effective rate was 90.32%, which was higher than that in the NB group. The difference in the efficacy was statistically significant (P < 0.05). Conclusion: PRF targeting the supraorbital nerve can effectively control the pain in the first branch of the trigeminal nerve after herpes, enhance sleep quality, and reduce the dose of pregabalin. Thus, this study shows that PRF is safe under ultrasound guidance and is worthy of clinical application. [ABSTRACT FROM AUTHOR]

Active sacroiliitis and sacroiliac joint dysfunction represent a common cause of low back pain in the population and are cause of patients' quality of life reduction and disability worldwide. The use of musculoskeletal ultrasound allows to easily identify the sacroiliac joints and to study every pathological condition affecting its most dorsal part; moreover, musculoskeletal ultrasound allows to guide highly effective injective procedures aimed at improving patients' symptoms and enhance their well-being. This paper aims to briefly explain for the musculoskeletal sonographer the anatomy and biomechanics of the sacroiliac joints, the correct ultrasound scanning method for their visualization and the most appropriate ultrasound guided injection technique to help dealing with the diagnostic and management of sacroiliac joint pain in the everyday scenario. [ABSTRACT FROM AUTHOR]

Objectives: Emergency treatment of patients with severe subphrenic vascular trauma often adopts resuscitative thoracotomy or endovascular balloon. This case report proposes a non-invasive method to treat patients with vascular trauma, mainly through ultrasound-guided positioning of the proximal aorta and applying pressure to occlude the aorta and limit the distal blood flow, using bedside ultrasound to achieve accurate compression, continuous monitoring of its efficacy, and early detection of the recovery of autonomic circulation in patients with cardiac arrest. Methods: We introduced a case of left iliac artery injury caused by a knife wound and subsequent cardiac arrest. Results We tried to externally compress the proximal aorta under bedside US guidance to achieve and maintain the recovery of the autonomic circulation. This allowed the patient to be transferred from the emergency department to the operating room. Conclusion: This case demonstrated that ultrasound-guided proximal external aortic compression can be used as a bridge for further treatment of patients with vascular trauma, such as resuscitative thoracotomy or endoaortic balloon or covered stent occlusion. [ABSTRACT FROM AUTHOR]

Purpose: To assess the technical success, safety and early efficacy of Morton neuroma (MN) cryoneurolysis. Materials and Methods: Retrospective review of 54 consecutive patients with MN treated with cryoneurolysis after failure of conservative treatment, from September 2022 to June 2023. Outcomes measurements included technical success (defined a successful ultrasound-guided placement of the cryoprobe), procedural safety according to Cirse classification and change in 6 months post-procedure by pain numeric rating scale (pNRS). Results: A total of 59 MN were treated during 55 procedures. Mean procedure duration was 47 min, all patients were discharged 2 h after the intervention. Technical success was 98.1%. No Cirse grade 3, 4 or 5 complication was reported. Three grade 2 complication occurred, including two chilblain-type lesions and one bone insufficiency fracture. At 6 months post-procedure, pNRS score was significantly decreased (2.7 ± 2.2 vs 7.1 ± 1.1) (p < 0.0001), with a mean score decrease of 4.1points. Thirty-two patients (60.4%) reported a complete pain relief, 15 (28.3%) a partial pain relief and 6 (11.3%) no pain relief, or increased pain. Conclusion: Cryoneurolysis seems to be safe for the treatment of Morton neuroma. Six-month pain relief is promising and needs to be confirmed at long term. [ABSTRACT FROM AUTHOR]

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Introduction: Outcomes after ultrasound-only percutaneous nephrolithotomy (PCNL), in which no fluoroscopy is used, are not well known. The goal of this study was to compare outcomes of ultrasound-only and fluoroscopy-directed PCNL. Materials and Methods: Prospectively collected data from the Registry for Stones of the Kidney and Ureter database were reviewed for all patients who underwent PCNL at one academic center from 2015 to 2021. Primary outcomes were complications and stone-free rates (no residual fragments ≥3 mm). Results: Of the 141 patients who underwent ultrasound-only PCNL and 147 who underwent fluoroscopy-directed PCNL, there was no difference in complication rates (15% vs 16%, p = 0.87) or stone-free status (71% vs 65%, p = 0.72), respectively. After adjusting for body mass index, American Society of Anesthesiologists (ASA), stone size, and stone complexity by Guy score, ultrasound-only PCNL was not associated with any increased odds of complications (odds ratio [OR] 0.7, 95% confidence interval [CI] 0.3-1.6, p = 0.41) or residual stone fragments ≥3 mm (OR 1.0, 95% CI 0.5-1.9, p = 0.972) compared with fluoroscopy-directed PCNL. Ultrasound-only PCNL was associated with shorter operative time (median 99.5 vs 126 minutes, p

Background Prostate biopsies are primarily conducted using either the transrectal or transperineal approach, with the ultrasound probe positioned in the rectum to obtain a clear view of the prostate. Reports on the utilization of transperineal prostate biopsies with the ultrasound probe placed on the perineal skin are limited. Methods A retrospective investigation was conducted on 119 patients who underwent transperineal ultrasound guided transperineal prostate biopsy (TP-TPPB). Additionally, 85 patients who underwent transrectal ultrasound guided transperineal prostate biopsy (TR-TPPB) were included as controls. The prostate cancer detection rates (PCDRs) and postoperative complication rates were compared between the two groups, and their application values were also evaluated. Results The overall PCDRs were 35.3% (42/119) in the TP-TPPB and 32.9% (28/85) in the TR-TPPB group (χ2 = 0.122, p = 0.727). When categorized by PSA level, there was no significant difference between the two groups in PCDRs in any category (p > 0.05). However, the single-needle PCDRs in some regions (L4, L5, R2, and apex) showed significant differences (p

BackgroundHerpes zoster (HZ) in the perineal area is a rare disease. There are limited treatment options for this disease. This study aimed to assess the efficacy of ultrasound combined with digital subtraction angiography (DSA)-guided pulsed radiofrequency (PRF) for perineal herpes zoster-related pain.MethodsTwo hundred and twelve patients with perineal HZ were enrolled at the pain department. From January 1, 2018 to December 30, 2019, patients with HZ in the perineal area were treated with PRF under DSA guidance, and from January 1, 2020 to October 30, 2023, patients with HZ in the perineal area were treated with PRF under ultrasound combined with DSA guidance. The included patients were divided into two groups: DSA group and ultrasound + DSA group. The visual analog scale (VAS), central sensitization inventory (CSI), sleep quality scores (SQS), the 36-Item Short Form Health Survey questionnaire (SF-36) at baseline and after the PRF treatment were analyzed to evaluate clinical efficacy.ResultsThe mean VAS scores, CSI scores, SQS, and SF-36 scores were statistically significantly lower after treatment compared to baseline (p 0.05). The time it took from the start of the puncture to the successful puncture was significantly shorter in the ultrasound + DSA group compared to the DSA group (41.2 ± 21.2 vs. 48.1 ± 20.3, p = 0.035). The ultrasound + DSA group had a higher percentage of satisfaction with the procedure than the DSA group (90/99, 90.9% vs. 62/78, 79.5%, p = 0.030). A total of 27 postoperative complications occurred. The incidence of puncture site hematoma was significantly higher in the DSA group (10/78, 12.8%) than that in the ultrasound + DSA group (4/99, 4.0%) (p = 0.032).ConclusionPRF can reduce pain from HZ in the perineal region, alleviate central sensitization, enhance sleep quality, and improve overall quality of life. When PRF is performed under ultrasound guidance combined with DSA, it shortens the puncture time and reduces the risk of hematoma formation at the puncture site, making it the recommended method for clinical use.

Background: Ultrasound has become the standard of care for the insertion of central venous catheters (CVCs) in the intensive care unit. With the introduction of ultrasonography in CVC insertion, there has been an improvement in the success rate and a dramatic decrease in the rate of complications. Aims and Objectives: The aim of this study was to compare the safety and ease of insertion of ultrasonically guided cannulation of the internal jugular vein (IJV) with that of the supraclavicular subclavian vein (SCV) in adult patients undergoing various surgical procedures. Materials and Methods: All the patients in whom central venous cannulation was planned were assigned to two groups. Group I underwent ultrasound-guided IJV while as Group II underwent cannulation ultrasound-guided SCV cannulation. A comparison was made between the two groups, of the success rates, durations of procedure, number of attempts at needle redirections, difficulties if any during insertion of guidewires, and the complications encountered. Results: The IJV group had a higher proportion of first-attempt success (93.2% versus 62.7%). The IJV group had a lesser incidence (3.2%) of complications such as guidewire progression and needle redirections compared with SCV (15.2%). The frequency of adverse events did not differ between the two study groups with an incidence in 3.2% in IJV group and 9.6% in the subclavian group. Higher first-attempt success rates and fewer procedural complications were seen with ultrasound-guided IJV. Conclusion: IJV central venous catheterization is an easier and less invasive and less risky procedure for patients.

AbstractPurpose This study aimed to compare the efficacy and safety of ultrasound-guided RFA and MWA in the treatment of unifocal PTMC.Methods This retrospective study included 512 patients with 512 unifocal papillary thyroid microcarcinomas (PTMCs) who underwent RFA (n = 346) and MWA (n = 166) between January 2021 and December 2021. The volumes of the ablation areas were measured during follow-up, and the volume reduction rates were evaluated. The ablation duration, volume of hydrodissection, and ablation-related complications were also compared between the groups.Results All lesions received complete ablation and no local or distant recurrences were observed in the two groups. A larger volume of isolation liquid was used for RFA than for MWA (p = 0.000). Hoarseness occurred in seven patients who underwent RFA (p = 0.102). At the 1-week follow-up, the mean volume of the areas ablated by RFA was smaller than that of the areas ablated by MWA (p = 0.049). During follow-ups at months 3, 9, 12, 15, and 18, the mean volumes of the ablated areas were larger in the RFA group than in the MWA group (all, p

Purpose: To compare the safety and efficacy of needle-perc-assisted endoscopic surgery (NAES) and retrograde intrarenal surgery (RIRS) for the treatment of 1- to 2-cm lower-pole stones (LPS) in patients with complex infundibulopelvic anatomy. Methods: Between June 2020 and July 2022, 32 patients with 1- to 2-cm LPS and unfavorable lower-pole anatomy for flexible ureteroscopy were treated with NAES. The outcomes of these patients were compared with patients who underwent RIRS using matched-pair analysis (1:1 scenario). The matching parameters such as age, gender, body mass index, stone size, hardness, and pelvicalyceal anatomy characteristics including infundibular pelvic angle, infundibular length, and width were recorded. Data were analyzed using the Student's t-test, Mann–Whitney U test, and Fisher's exact test. Results: The two groups had similar baseline characteristics and lower-pole anatomy. The stone burden was comparable between both groups. NASE achieved a significantly better initial stone-free rate (SFR) than RIRS (87.5% vs 62.5%, p = 0.04). The auxiliary rates for the NAES and RIRS groups were 12.5% and 31.3%, respectively (p = 0.13). Finally, the SFR after 1 month follow-up period was still higher for the NAES group than RIRS group (93.8% versus 81.3%), but the difference was not statistically significant (p = 0.26). Concerning the operation duration, overall complication rates, and postoperative hospital stay, there were no differences between two groups. Conclusion: Compared to RIRS for treating 1- to 2-cm LPS in patients with unfavorable infundibulopelvic anatomy for flexible ureteroscopy, NAES was safe and effective with higher SFR and similar complication rate. [ABSTRACT FROM AUTHOR]

Objective To evaluate the clinical effect of ultrasound-guided intercostal nerve pulsed radiofrequency on the treatment of postherpetic neuralgia in the upper thoracic segment after herpes zoster infection. Methods A total of 67 patients with postherpetic neuralgia in the intercostal nerve of the thoracic region (segments 1, 2, and 3) and back region were included in this study. The patients were randomly assigned into an experimental group and a control group based on the type of treatment method. The experimental group consisted of 34 participants, including 15 males and 19 females, with an average age of (50.6±11.5) years. Pulsed radiofrequency procedure was performed on the intercostal nerves of segments 1, 2, and 3 under the ultrasound guidance for the subjects in the experimental group. The control group comprised 33 subjects, including 16 males and 17 females, with an average age of (51.5±12.7) years. Intercostal nerve block procedure was performed on segments 1, 2, and 3 under the ultrasound guidance for the patients in the control group. The visual analog scale (VAS) pain scores and Pain DETECT scale scores were compared before the treatment and 1, 3, 6, and 12 months after the treatment for the two groups. The recurrence rate of symptoms within 1 year after the treatment was determined and compared between the two groups. Results Complete follow-up was achieved in the 67 patients after the treatment, and the study subjects did not present with adverse reactions. The VAS pain scores and Pain DETECT scale scores at 1, 3, 6, and 12 months after the treatment were significantly better in the experimental group than in the control group (P < 0.05). The VAS pain scores and Pain DETECT scale scores at 1, 3, 6, and 12 months after the treatment were significantly improved compared with the pre-treatment scores for the two groups (P < 0.05). The recurrence rate of symptoms within 1 year after the treatment was significantly lower in the experimental group than in the control group (P < 0.05). These results showed that pulsed radiofrequency method was more effective for the treatment of postherpetic neuralgia in the upper thoracic segment after herpes zoster infection and had less adverse effects compared with the intercostal nerve block approach. Conclusion Ultrasound-guided intercostal nerve pulsed radiofrequency treatment is effective and safe for the treatment of postherpetic neuralgia in the upper thoracic segment after herpes zoster. [ABSTRACT FROM AUTHOR]

Lumbar spinal stenosis (LSS) occurs when bony, ligamentous, and synovial elements of the lower axial spine degenerate and overgrow, compressing neural and vascular elements in the spinal canal. Compression can cause static back pain, radicular lower extremity pain, or neurogenic claudication. Radiological and clinical findings are needed to diagnose lumbar stenosis. In this framework, caudal epidural steroid injection (ESI) is a standard treatment. The volume injected and needle positioning are the main issues that could compromise the effectiveness of the epidural injection. However, ultrasound-guided caudal epidural injections have become more common in recent years. Since Klocke and colleagues described the ultra-sound-guided caudal block in 2003, it has grown in popularity. Multiple ethnic studies have reported ultrasound-guided caudal injection success rates of 96.9-100%. Color Doppler ultrasonography can also determine if a drug solution reaches the lumbosacral region. We enrolled 42 patients with lumbar spinal stenosis, persistent lumbosciatalgia, and neurogenic claudicatio unresponsive to painkillers who were not surgical candidates. Each patient receives four weekly injections for four weeks. If the patient responds to treatment but still has pain, monthly injections are needed to reach and maintain the benefit. Treatment will be changed if the patient does not respond after 4 caudal injections. Sterile caudal epidural injections are performed with ultrasound guidance and a spinal needle 21G. Triamcinolone 40 mg, levobupivacaine 10 mg, and physiological solution 10 ml are delivered. Each patient received an average of 4 injective treatments (4±2, Means 4, SD 2). Data analysis shows that the treatment reduced pain significantly before and after therapy, which persisted after 3 months. Caudal epidural injection is one of the most common conservative treatments for chronic low back pain with radiculopathy, and lidocaine alone or with steroids is effective. In this framework, the two main literature issues about caudal epidural injection effectiveness on lumbar pain are correct. Therefore, 10 ml is suitable and effective for treating symptoms without side effects. Pain reduction of over 50% from start to finish and three-month follow-up have shown significant results in pain control and disability improvement. Finally, caudal epidural injection for lumbar spinal stenosis symptoms is effective, safe, and provides long-term pain relief. [ABSTRACT FROM AUTHOR]

Background: Intra-articular glucocorticoid injection (IAGI) is widely used for treatment of knee osteoarthritis (OA) flares. Response rates are generally around 70%. Several studies have tried to identify predictors of good response, but response to ultrasound (US)-guided injection has not yet been investigated. This study aimed to identify the predictors of response to IAGI performed under US guidance in patients with primary knee OA. Materials and methods: A total of 116 patients (116 knees) presenting with unilateral or bilateral primary knee OA were enrolled for this prospective single-center study. All were aged >40 years and met the American College of Rheumatology (ACR) criteria for knee OA. Demographic, clinical, laboratory, and imaging data were collected, injection was performed using US guidance, and tolerance was assessed. The primary efficacy endpoint was ≥40% reduction in total WOMAC score (WOMAC40). Univariate and multivariate logistic regression analyses were conducted to identify the predictors of response. Results: The mean age of the patients was 64.2 ± 9.4 years and mean BMI was 29.9 ± 3.8 kg/m2. Total WOMAC40 response rate was 61.2%. In multivariate analysis, the independent predictors of response were BMI <30 kg/m² (OR = 0.38 [0.16 -- 0.89], p = 0.025) and ESR <20 mm (OR = 0.27 [0.08 -- 0, 90], p = 0.033). Conclusion: Knee OA patients with BMI <30 kg/m2 and/or ESR <20 mm have higher chance of having satisfactory response to US-guided IAGI. Clinical and radiographic severity and age do not seem to affect the probability of response. [ABSTRACT FROM AUTHOR]

The article presents the results of a randomized controlled trial assessing the efficacy of ultrasound-guided suprazygomatic maxillary nerve block (MNB) in alleviating the pain in patients undergoing functional endoscopic sinus surgery (FESS). The study collected data like patient satisfaction, postoperative complications like nausea, and total rescue analgesia. Based on the results, MNB can be safe and effective to use during FESS.

Copyright of Pamukkale Medical Journal is the property of Pamukkale Journal of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Centrally inserted central catheters (CICCs) are increasingly used in neonatal care. CICCs have garnered attention and adoption owing to their advantageous features. Therefore, achieving clinical competence in ultrasound-guided CICC insertion in term and preterm infants is of paramount importance for neonatologists. A safe clinical training program should include theoretical teaching and clinical practice, simulation and supervised CICC insertions. Methods: We planned a training program for neonatologists for ultrasound-guided CICCs placement at our level III neonatal intensive care unit (NICU) in Modena, Italy. In this single-centre prospective observational study, we present the preliminary results of a 12-month training period. Two paediatric anaesthesiologists participated as trainers, and a multidisciplinary team was established for continuing education, consisting of neonatologists, nurses, and anaesthesiologists. We detail the features of our training program and present the modalities of CICC placement in newborns. Results: The success rate of procedures was 100%. In 80.5% of cases, the insertion was obtained at the first ultrasound-guided venipuncture. No procedure-related complications occurred in neonates (median gestational age 36 weeks, IQR 26–40; median birth weight 1200 g, IQR 622–2930). Three of the six neonatologists (50%) who participated in the clinical training program have achieved good clinical competence. One of them has acquired the necessary skills to in turn supervise other colleagues. Conclusions: Our ongoing clinical training program was safe and effective. Conducting the program within the NICU contributes to the implementation of medical and nursing skills of the entire staff. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy of shockwave therapy for secondary hand tendon adhesions following palm, wrist, and forearm injuries under musculoskeletal ultrasound-guided localization. Methods Eighty patients with secondary hand tendon adhesions after palm, wrist, and forearm injuries were randomly divided into treatment group and control group, with 40 cases in each group. Both groups received conventional rehabilitation treatments for hand tendon adhesions, such as wax therapy, joint mobilization, and occupational therapy. Patients in the control group underwent shockwave therapy based on manual examination to determine the sites of tendon adhesions according to joint mobility limitations. Patients in the treatment group underwent musculoskeletal ultrasound examination to identify the sites of tendon adhesions, followed by marking and localization, before receiving shockwave therapy. Both groups underwent rehabilitation treatment for 4 weeks. Musculoskeletal ultrasound assessment, total active motion (TAM) of hand tendons, Visual Analog Scale (VAS) pain score, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores were evaluated before and after treatment. Results There were no statistically significant differences in hand tendon adhesion degree, TAM, VAS pain score, and DASH scores between the two groups before treatment (P＞0.05), demonstrating comparability. After 4 weeks of treatment, both groups showed significant improvement in hand tendon adhesion degree, increased TAM, reduced VAS pain score, and improved DASH scores. However, the treatment group exhibited more significant improvements in hand tendon adhesion degree, greater increase in TAM, more pronounced decrease in VAS pain score, and greater improvement in DASH scores compared to the control group, with statistically significant differences (P＜0.01). Conclusion Shockwave therapy guided by musculoskeletal ultrasound localization combined with conventional rehabilitation treatment can significantly improve secondary hand tendon adhesions and restore partial hand function. [ABSTRACT FROM AUTHOR]

Ultrasound plays a major role in neonatal/pediatric vascular access, both for venous access and for arterial access, not only just for the insertion of intravascular catheters, but also for many other issues related to this type of maneuver. This "global use of ultrasound" includes a systematic and consistent adoption of this technology for several steps of vascular access: (a) the pre-procedural assessment/evaluation of the vessels, (b) the ultrasound-guided puncture and cannulation of arteries and veins, (c) the real-time diagnosis of immediate, puncture-related complications, (d) the so-called "tip navigation" (i.e., real-time intra-procedural assessment of the direction and trajectory of the guidewire and/or of the catheter inside the vasculature), (e) the so-called "tip location" (i.e., intra-procedural or post-procedural assessment of the proper position of the tip of the catheter), and (f) the early diagnosis and/or management of most non-infective late complications. Conclusion: Therefore, any vascular access expert (nurse or physicians) should have documented competency in the use of ultrasound. This knowledge should include the use of ultrasound for assessment of vessels, for catheter insertion, for proper placement of the tip, and for real-time detection of complications. What is Known: • Ultrasound is obviously useful for vascular access procedures in neonates and children. What is New: • Recent evidence suggests that ultrasound is useful for many purposes in the field of vascular access (preprocedural scan, ultrasound-guided puncture, tip navigation, tip location, diagnosis of most non-infective complications). • Recent evidence also suggests that radiological methods no longer play any role in the insertion of vascular accesses in neonates and children. [ABSTRACT FROM AUTHOR]

Point-of-care ultrasound (POCUS) has been established as an essential bedside tool for real-time image guidance of invasive procedures in critically ill neonates and children. While procedural guidance using POCUS has become the standard of care across many adult medicine subspecialties, its use has more recently gained popularity in neonatal and pediatric medicine due in part to improvement in technology and integration of POCUS into physician training programs. With increasing use, emerging data have supported its adoption and shown improvement in pediatric outcomes. Procedures that have traditionally relied on physical landmarks, such as thoracentesis and lumbar puncture, can now be performed under direct visualization using POCUS, increasing success, and reducing complications in our most vulnerable patients. In this review, we describe a global and comprehensive use of POCUS to assist all steps of different non-vascular invasive procedures and the evidence base to support such approach. Conclusion: There has been a recent growth of supportive evidence for using point-of-care ultrasound to guide neonatal and pediatric percutaneous procedural interventions. A global and comprehensive approach for the use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures. What is Known: • Point-of-care ultrasound has been established as a powerful tool providing for real-time image guidance of invasive procedures in critically ill neonates and children and allowing to increase both safety and success. What is New: • A global and comprehensive use of point-of-care ultrasound allows to assist all steps of different, non-vascular, invasive procedures: from diagnosis to semi-quantitative assessment, and from real-time puncture to follow-up. [ABSTRACT FROM AUTHOR]

Objective: To analyze the influencing factors of complications caused by ultrasound interventional therapy in patients with advanced liver cancer. Method: A total of 120 patients with advanced liver cancer who underwent ultrasound interventional therapy in our hospital from February 2019 to February 2023 were selected for the study. The incidence of complications was recorded after treatment, and the patients were divided into complication group(36 cases) and non-complication group(84 cases) according to the occurrence of complications. The general characteristics of the two groups of patients { gender, age, presence or absence of underlying diseases, TNM stage, Child-Pugh classification, morphological classification, tumor volume, ascites, portal hypertension, blood supply,albumin(ALB) and serological indicators [ hemoglobin(Hb), platelet(PLT), prothrombin time(PT), total bilirubin(TBIL), alanine aminotransferase(ALT), aspartate aminotransferase(AST) ] were analyzed, and a logistic model was established. Univariate and multivariate analyses were performed on the effects of general characteristics on complications after ultrasound interventional therapy in patients with advanced liver cancer. Results: The incidence of complications in 120 patients after ultrasound intervention was 30.00%.The patients with Child-Pugh B grade, ascites + and ALB ＜ 30 g/L in the complication group were higher than those in the non-complication group(P＜0.05). The results of univariate analysis showed that Child-Pugh classification, ascites and ALB were the influencing factors of complications after ultrasound interventional therapy in patients with advanced liver cancer(P＜0.05). Multivariate logistic analysis showed that Child-Pugh B grade, ascites, and ALB ＜ 30 g/L were all independent risk factors for complications after ultrasound interventional therapy in patients with advanced liver cancer(P＜0.05). Conclusion: Child-Pugh classification, ascites and ALB are all independent factors leading to complications after ultrasound interventional therapy in patients with advanced liver cancer. Only by strengthening prevention and treatment intervention for such influencing factors as soon as possible can we effectively reduce the incidence of complications in patients with advanced liver cancer. [ABSTRACT FROM AUTHOR]

Copyright of Vascular Access is the property of Canadian Vascular Access Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Stellate ganglion block (SGB) has been shown to reduce perioperative complications in various surgeries. Because laparoscopic techniques and instruments have advanced during the past two decades, laparoscopic liver resection is being increasingly adopted worldwide. Lesser blood loss, fewer postoperative complications, and shorter postoperative hospital stays are the advantages of laparoscopic liver resection, as compared to conventional open surgery. There is an urgent need for an effective intervention to reduce perioperative complications and accelerate postoperative recovery. This study investigated the effect of ultrasound-guided SGB on enhanced recovery after laparoscopic partial hepatectomy. Methods We compared patients who received SGB with 0.5% ropivacaine (group S) with those who received SGB with 0.9% saline (group N). A total of 58 patients with partial hepatectomy were enrolled (30 S) and (28 N). Before induction of anesthesia, SGB was performed with 0.5% ropivacaine in group S and 0.9% saline in group N. Main outcome: Comparison of serum inflammatory cytokines concentration at each time point. Results Main outcome: When comparing IL-6 and IL-10 concentrations among groups, group S showed less variation over time compared to group N. For comparison between groups, the serum IL-6 concentration in group S was lower than that in group N at 6 and 24 h after operation (P

Objective: To explore the effects of ultrasound-guided serratus anterior plane block (SAPB) and thoracic paravertebral block (TPVB) on opiate dosage and stress response in patients undergoing thoracoscopic radical resection of lung cancer. Methods: A total of 130 patients undergoing elective thoracoscopic radical resection of lung cancer in Changshu Second Peoples Hospital between June 2019 and January 2022 were enrolled. According to the random number table method, they were divided into SAPB group (65 cases, ultrasound-guided SAPB before anesthesia induction) and TPVB group (65 cases, ultrasound-guided TPVB before anesthesia induction). After surgery, all underwent patient-controlled intravenous analgesia with analgesia pumps. The timepoints including preoperative, thoracic closure, and postoperative 2, 6, and 24 hours were set as T1, T2, T3, T4 and T5, respectively, and the intraoperative blood loss and fluid supplement, operation time, intraoperative dosages of sufentanil and propofol, and postoperative cumulative dosages of sufentanil at T3, T4 and T5 in the two groups were recorded. At T3, T4 and T5, pain changes were evaluated by Prince-Henry scores. The levels of prostaglandins E2 (PGE2), norepinephrine (NE) and cortisol (Cor) were detected by enzyme-linked immunosorbent assay. The partial pressure of arterial oxygen was detected by a blood gas analyzer, and oxygenation index (OI) was calculated. The occurrence of postoperative adverse events (PAEs) in the two groups was recorded. Results: From T3 to T5, levels of PGE2, NE, and Cor in SAPB group were significantly lower than those in TPVB group (P＜0.05). OI at T2 to T4 was significantly lower than that at T1, while OI at T5 was significantly higher than that at T2, T3, and T4 in both groups (P＜0.05). From T2 to T4, OI in SAPB group was significantly higher than that in TPVB group (P＜0.05). Compared with TPVB group, the cumulative consumption of sufentanil in SAPB group slightly decreased from T3 to T5, but the differences were not statistically significant (P>0.05). The incidences of nausea and vomiting (6.15% vs 18.46%, χ2=4.561, P=0.033), atelectasis(3.08% vs 12.31%, χ2=3.900, P=0.048) and hypotension (7.69% vs 20.00%, χ2=4.127, P=0.042) in SAPB group were lower than those in TPVB group. Conclusion: Compared with TPVB, ultrasound-guided SAPB can relieve stress response, promote the recovery of pulmonary oxygenation and reduce PAEs in patients undergoing thoracoscopic radical resection of lung cancer, but whether it can significantly reduce the dosage of opiates needs to be further explored.

Objective: To observe the application and clinical efficacy of ultrasound-guided acupotomy combined with joint mobilization surgery in the treatment of frozen shoulder. Methods: One hundred and twenty patients who visited the Department of Orthopedics and Traumatology of Beijing Daxing District Hospital of Integrated Chinese and Western Medicine from September 2020 to April 2022 were included.The patients were divided into experimental group (n=60) and control group (n=60) according to a random number scale. The experimental group was treated with ultrasound-guided acupotomy combined with joint mobilization surgery,and the control group was treated with conventional acupotomy combined with joint mobilization surgery. Before treatment, 1 day and 1 month after treatment, inferior glenohumeral joint capsule thickness (ICT) under ultrasound, visual analog pain score (VAS score) and shoulder joint function score (Constant Murley scale score) were evaluated to compare the clinical efficacy of the two groups. Results: One day and one month after treatment, the ICT values of both groups decreased to below 3 mm, and the ICT value in experimental group was significantly lower than that in control group (P＜0.05); the VAS scores were lower than 4 points in both groups, and the VAS score was about 2 points in the experimental group, with a significantly higher compared to the control group (P＜0.05); the Constant-Murley scores were higher than 20 points in both groups, and the Constant-Murley score was higher than 30 points in experimental group, with a significantly higher compared to the control group (P＜0.05). Conclusion: Ultrasound-guided acupotomy combined with joint mobilization for the treatment of frozen shoulder has obvious clinical efficacy.

Objective To compare the efficacy and safety of percutaneous dilational tracheostomy（PDT）using fiberoptic bronchoscope，ultrasound guidance and anatomic landmark localization. Methods In this retrospective cohort，101 patients undergoing PDT were enrolled and divided into bronchoscope-guided group（n = 39），ultrasound-guided group（n = 27），and anatomical landmark localization group（n = 35）. Demographic data，general condition，surgical condition，postoperative complication and clinical prognosis were collected. Results No statistical significance was found in age，sex，cause of ICU stay，primary disease and preoperative coagulation status（all P > 0.05）. In the ultrasound-guided group，preoperative Sequential Organ Failure Assessment（SOFA）score was higher，the operation time was shorter and intraoperative blood loss was less compared with those in the other two groups（P < 0.05/3）. The PaCO2 in the anatomical landmark localization group was lower than that in the ultrasound-guided group（P < 0.05/3）. Conclusions Real-time ultrasound guidance during PDT can be employed to identify the anatomical structures of the neck，which can shorten the operation time，reduce intraoperative bleeding and avoid hyperventilation in patients with severe diseases. Ultrasound-guided PDT may serve as an alternative regimen for PDT using bronchoscope or anatomical landmark localization.

Background: We have developed a new approach for peripherally inserted central catheter (PICC) insertion that we think has several advantages, including ease of insertion, access to a larger vein and patient comfort. Methods: In this case series report, the first 19 cases were audited. Results: All PICCs were inserted without complications; 17 on the first attempt. Conclusion: We conclude that the novel approach to the axillary vein for PICC insertion is feasible and appears to be safe when performed by an experienced operator. [ABSTRACT FROM AUTHOR]

Jiaojiao Dong,&ast; Zhousheng Jin,&ast; Hongfei Chen, Nana Bao, Fangfang Xia&ast; Department of Anesthesiology, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang Province, 325000, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Fangfang Xia, Department of Anesthesiology, The First Affiliated Hospital, Wenzhou Medical University, Shangcai Village, Nanbaixiang Town, Ouhai District, Wenzhou, Zhejiang Province, 325000, People’s Republic of China, Email Helenxia4271@163.comPurpose: We examined whether the addition of sufentanil to local anesthetics improves the quality of continuous femoral nerve block in patients undergoing total knee arthroplasty (TKA).Patients and Methods: With institutional ethical approval and having obtained written informed consent from each, 35 patients scheduled for elective bilateral TKA with ASA I or II physical status were studied. Bilateral femoral perineural catheters were preoperatively inserted. Both-sided catheters were randomly assigned to receive perineural ropivacaine of 0.2% plus 0.5μg/mL sufentanil deemed as RS group or 0.2% ropivacaine alone deemed as R group at the end of surgery. Visual analogue pain scores (VAS) during activity and at rest of each lower limb were recorded at 6,12,18,24,30,36,42 and 48h after surgery. During the first 48 postoperative hours, the number and reason of patients sleep interruption at night, the number of painful compressions, patient satisfaction and morphine requirements were recorded for each lower limb of patients.Results: Pain scores of RS group on movement were significantly lower than R group, but no difference was noted at rest. When compared to R group, RS group had a lower incidence of sleep interruption at night, fewer painful compressions, higher satisfaction scores and less morphine requirement.Conclusion: The addition of sufentanil to ropivacaine improved analgesia quality of continuous femoral nerve block after arthroplasty. Keywords: continuous femoral nerve block, ultrasound guidance, total knee arthroplasty, analgesia, ropivacaine

Pseudoaneurysms are a commonly encountered pathology, though pseudoaneurysms of the visceral arteries are a less frequent, but potentially deadly entity. Transarterial embolization is the typical treatment of visceral pseudoaneurysms, but success is dependent on anatomy that is conducive to selecting the supplying vessel. Abdominal ultrasound is a viable method to effectively treat visceral pseudoaneurysms when transarterial embolization is not possible. It is also an excellent example of the growing utilization of ultrasound guidance in various interventional radiologic procedures. The usefulness of ultrasound is demonstrated in this case report, where a left gastric artery pseudoaneurysm was embolized through ultrasound guidance.

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. [ABSTRACT FROM AUTHOR]

Background and Objectives: The use of ultrasound has gained popularity in the field of regional anaesthesia for upper limb surgical procedure, as it provides a direct visualization of the anatomic structures and allows a dynamic vision of needle movement and local anaesthetic spread. In the present study, we chose Buprenorphine as an adjuvant to Ropivacaine for ultrasound guided supraclavicular brachial plexus block based on hypothesis that the duration of action after single injection is limited when local anaesthetic alone is used and to prolong its effect, wide range of additives have been used in combination with local anesthetics to promote analgesia. Methodology: After obtaining ethical committee clearance, 60 patients of either sex in the age group of 25 to 60 years, with ASA status I and II, undergoing elective upper limb surgeries under ultrasound guided supraclavicular brachial plexus block, at Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Mandya, were randomly divided into two groups of 30 each. Group RP received Ropivacaine 0.75% 19 ml + Normal saline 1 ml (placebo). Group RB received Ropivacaine 0.75% 19 ml + Buprenorphine 75mcg (1ml). The time of onset and duration of sensory and motor blockade, duration of analgesia, occurrence of haemodynamic instability and adverse events were noted and the results were statistically analyzed, considering a P value of < 0.05 to be statistically significant. Results: The time of onset of sensory block in Group RP was of 6.7±0.51 minutes and in Group RB was of 4.533±0.57 minutes. The sensory block lasted for 334.33±15.01 minutes in Group RP and 606.17±88.29 minutes in Group RB. The onset of motor block in Group RP was 9.3±0.53 minutes and in Group RB was 6.1±0.54 minutes. The motor block lasted for 228.67±11.958 minutes in Group RP and 517.67±103.94 minutes in Group RB. The duration of analgesia in Group RP was 317.50±15.578 minutes and in Group RB was 687.83±19.059 minutes. There was statistically significant difference found between two groups with respect to onset of sensory and motor blockade, duration of sensory and motor blockade and duration of analgesia (with P value <0.001). None of the patients had any other complications in either group. Interpretation and Conclusion: Hence 0.75% Ropivacaine with buprenorphine 75mcg produced satisfactory sensory and motor blockade and also prolonged duration of analgesia when used for supraclavicular brachial plexus block under ultrasound guidance. [ABSTRACT FROM AUTHOR]

Introduction: Epigastric hernia repair is a common procedure performed on pediatric patients. These hernias have been demonstrated to be readily identified by ultrasound. This manuscript describes and assesses a novel technique in which ultrasound is used to identify and repair the hernias in a minimally invasive manner. Methods: A retrospective chart review evaluates all the ultrasound-guided epigastric hernia repairs done with prolene suture at one institution over 20 months. Operative details and postoperative complications were compared to patients who underwent traditional open epigastric hernia repair at the same institution during the same time frame. Results: Thirty-two pediatric patients underwent epigastric hernia repair between May 2021 and December 2022. Thirteen (41%) underwent the ultrasound-guided technique with prolene suture and using only a meniscus needle and no incision. Nineteen (59%) underwent standard open repair. There were no recurrences or postoperative complications in either group. The average operative time for the ultrasound hernia repair was 24.4 minutes, which was shorter than the average operative time of 33.6 minutes for the open repair (P = .08). In 3 ultrasound cases (23%), an additional epigastric hernia that had not been clinically apparent was identified and simultaneously repaired. Conclusions: Ultrasound-guided epigastria hernia repair is a feasible alternative to traditional open repair. It has a comparable safety and efficacy profile, has a short operative time, and has the advantages of being minimally invasive and having the ability to identify and repair concurrent epigastric hernias. [ABSTRACT FROM AUTHOR]

Introduction: Carpal tunnel syndrome (CTS) is a common complaint in the emergency department (ED) and accounts for approximately 90% of all peripheral neuropathies.6 Pain control from injection with corticosteroids into the carpal tunnel space is associated with multiple possible complications including atrophy, iatrogenic median nerve injury, and skin changes. Ultrasound (US)-guided mid-forearm median nerve block is an ED procedure that can be used to avoid direct injection into the carpal tunnel space. Here we present a case report proposing the use of US-guided mid-forearm block as a safe and effective adjunct to the management of acute pain caused by CTS. Case Report: A previously healthy 44-year-old, right-hand dominant female presented to the ED with left wrist pain. Her clinical exam andUS findings were consistent with CTS. Given her allergy to non-steroidal anti-inflammatory drugs, she was offered a median nerve block, which was performed in the ED. The patient reported continued pain relief 24 hours after discharge from the ED. Conclusion: There is limited data on the use of US-guided mid-forearm median nerve block as an acute pain management tool for CTS in the ED. The US-guided median nerve block done in the mid-forearm location can provide pain control for those with CTS while reducing the risk of complications associated with direct carpal tunnel injection. [ABSTRACT FROM AUTHOR]

Background: Insomnia has become increasingly prevalent in modern society and is notoriously difficult to treat. Many patients exhibit a poor response to pharmacological interventions. Stellate ganglion block (SGB) has emerged as an effective method for managing insomnia; however, its efficacy may be compromised in some patients, primarily due to a variant vertebral artery anatomy. Case presentation: This case report describes a patient with severe insomnia accompanied by anxiety. Through cervical ultrasound scanning, we identified richly branched cervical arteries at the C6-C7 segment of the vertebral artery, along with anatomical variations, which could pose a heightened risk for the traditional SGB procedure. Therefore, after carefully adjusting the patient's positioning, we proceeded with ultrasound-guided SGB using a lateral paravein out-of-plane approach. Clinical signs of successful insomnia symptoms alleviation were consistently observed after each block utilizing this alternative technique multiple times in a single patient. Conclusion: Our report reveals a new lateral paravein out-of-plane approach for ultrasound-guided SGB to treat insomnia, which might be considered an alternative method. More studies should be carried out to confirm the efficacy of this new approach. [ABSTRACT FROM AUTHOR]