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The Requisites of Needle-to-Nerve Proximity for Ultrasound-Guided Regional Anesthesia: A Scoping Review of the Evidence
  1. Faraj W. Abdallah, MD*,
  2. Alan J. R. Macfarlane, MBChB, MRCP, FRCA and
  3. Richard Brull, MD, FRCPC
  1. From the *Departments of Anesthesia, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; †Glasgow Royal Infirmary, Scotland, United Kingdom, ‡Toronto Western Hospital (University Health Network) and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
  1. *Address correspondence to: Richard Brull, MD, FRCPC, Department of Anesthesia and Pain Management, Toronto Western Hospital, 399 Bathurst St, Toronto, Ontario, Canada M5T 2S8 (e-mail: richard.brull{at}uhn.ca).

Abstract

This scoping review examines the literature to determine whether the position of the needle tip relative to the target nerve is accurately and reliably detected during ultrasound (US)–guided regional anesthesia. The requisites for successful and safe needle tip positioning relative to the target nerve include accurate and reliable needle presentation by the machine, needle interpretation by the operator, nerve presentation by the machine, and nerve interpretation by the operator. Failure to visualize the needle tip is a common occurrence, frequently prompting operators to use needle and probe maneuvers, which are not necessarily based on evidence. Needle tip interpretation often relies on surrogate indicators that have not been validated. The acoustic resolution of modern portable US machines limits the extent to which nerve microanatomy can be reliably presented. Finally, our interpretation of the sonographic end points for local anesthetic injection that best balance success and safety for US-guided regional anesthesia continues to evolve.

What's New In order to determine whether or not the position of the needle tip relative to the target nerve is accurately and reliably detected during US-guided regional anesthesia, the available literature is reviewed and interpreted to address the following 4 questions:

  1. Is the presentation of needle tip by the ultrasound machine accurate and reliable?

  2. Is the interpretation of the needle tip image by the operator accurate and reliable?

  3. Is the presentation of the nerve by the ultrasound machine accurate and reliable?

  4. Is the interpretation of the nerve image by the operator accurate and reliable?

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Footnotes

  • This work was supported by departmental funding.

    The authors declare no conflict of interest.

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