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Original research
Ultrasonographic needle tip tracking for in-plane infraclavicular brachialis plexus blocks: a randomized controlled volunteer study
  1. Trine Kåsine1,2,
  2. Luis Romundstad3,
  3. L A Rosseland1,2,
  4. Morten Wang Fagerland4,
  5. Paul Kessler5,
  6. Ivar Nagelgaard Omenås3,
  7. Anne Holmberg3 and
  8. Axel R Sauter1,3,6
  1. 1Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
  2. 2Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
  3. 3Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
  4. 4Oslo Centre for Biostatics and Epidemiology (OCBE) Research Support Services, Oslo University Hospital, Oslo, Norway
  5. 5Department of Anesthesiology, Intensive Care and Pain Medicine, Orthopedic University Hospital Friedrichsheim, Frankfurt am Main, Hessen, Germany
  6. 6Department of Anesthesia and Pain Medicine, Inselspital Bern University Hospital, Bern, Switzerland
  1. Correspondence to Dr Trine Kåsine, Anesthesiology, Oslo University Hospital, 0424 Oslo, Norway; trikaa{at}ous-hf.no

Abstract

Background Onvision is a new technology for needle tip detection and tracking in ultrasound-guided regional anesthesia. The system consists of a piezoelectric sensor close to the needle tip and an electronic console integrated in the ultrasound system. The needle tip is visualized by a green circle on the ultrasound screen. The aim of the study was to investigate the effect of the new needle tip tracking technology on in-plane infraclavicular plexus blocks.

Methods The study was a randomized, controlled, observer blinded cross-over trial in 26 healthy volunteers. Two specialists in anesthesiology performed an ultrasound-guided infraclavicular lateral sagittal brachial plexus block with and without needle tip tracking. Primary outcome was procedure time, measured from insertion of the needle until local anesthesia injection was completed. Secondary outcome measures included the number of hand movements and path lengths (assessed by hand motion analysis), block success rate, onset time and duration, discomfort experienced by the volunteers, and the anesthesiologists’ confidence as to whether their block would be successful or not.

Results Mean (SD) procedure time was 183.0 (56.1) s with and 206.8 (56.2) s without needle tip tracking (p=0.16). There were no significant differences in any of the secondary outcomes. Two volunteers’ experienced Horner syndrome after blocks without needle tip tracking. No other adverse events occurred during the study.

Conclusion Our study on needle tip tracking for infraclavicular blocks did not reveal any significant differences between active needle tip tracking and the control procedures, neither for primary outcome nor secondary outcome measurements.

Trial registration number NCT03631914

  • brachial plexus
  • technology
  • upper extremity
  • postoperative pain
  • regional anesthesia
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, an indication of whether changes were made, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/rapm-2020-101349

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    Footnotes

    • Contributors TK, LR, LAR, MWF, PK and ARS planned and designed the study. TK and INO were the anesthesiologist who performed the blocks on the volunteers. LR and AH did the testing of the volunteers. ARS oversaw the study and was responsible for the envelopes with the randomization. TK, LR, AH, INO and ARS collected and screened the data. MWF performed statistical analysis and calculations. TK, LR, LAR, MWF, INO, PK and ARS interpreted the data. All authors wrote and edited the manuscript. ARS designed the figures.

    • Funding This project has received funding from the European Union’s Horizon 2020 research and innovation programs (grant agreement 691262).

    • Competing interests B. Braun Melsungen AG and Philips Medical Systems International B.V. have been partners in the European Union’s Horizon 2020 program. The main task for Oslo University Hospital was to conduct preclinical and clinical studies to evaluate the OnvisionR needle tip tracking technology. Ultrasound system and disposables used in the study were provided by B. Braun Melsungen AG and Philips Medical Systems International B.V.

    • Patient consent for publication Not required.

    • Ethics approval Ethical approval was provided by the Committee for Medical Research Ethics, Region South East, Oslo, Norway on August 8, 2018 (2018/1098/REK-sør-øst). The study complied with the declaration of Helsinki.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. Please contact the corresponding author.