Ultrasonographic needle tip tracking for in-plane infraclavicular brachialis plexus blocks: a randomized controlled volunteer study

Trine Kåsine, Luis Romundstad, L A Rosseland, Morten Wang Fagerland, Paul Kessler, Ivar Nagelgaard Omenås, Anne Holmberg, Axel R Sauter, Trine Kåsine, Luis Romundstad, L A Rosseland, Morten Wang Fagerland, Paul Kessler, Ivar Nagelgaard Omenås, Anne Holmberg, Axel R Sauter

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.

Keywords: brachial plexus; postoperative pain; regional anesthesia; technology; upper extremity.

Conflict of interest statement

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.

© American Society of Regional Anesthesia & Pain Medicine 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ.

Figures

Figure 1
Figure 1
The Onvision needle tip tracking (NTT) technology. (A) A piezoelectric sensor is wrapped around the needle close to the needle tip. The arrow indicates the position of the sensor. The needle has no echogenic texture. (B) The design of the needle is comparable to a standard nerve block cannula with one tube for fluid injections and one electrical wire for signal transmission from the sensor to the connector. The same wire is used for electrical nerve stimulation while connecting the nerve stimulator to the connector. (C) The piezoelectric sensor on the needle collects the ultrasound waves which are sent out by the transducer. A signal processing unit calculates and projects the position of the sensor on the two-dimensional ultrasound image. The needle tip is visualized by a green circle overlay on the ultrasound image.
Figure 2
Figure 2
(A) A circle with green color represents the position of the needle tip on the ultrasound screen when the needle is in the ultrasound plane. For in-plane procedures, the needle tip is located on the circle line, opposite to the side of needle insertion. (B) When the needle tip is outside of the ultrasound plane, the system can still pick up a faint signal. The needle tip is then indicated by a red and a blue circle of increasing diameter on the ultrasound screen (dependent on the distance from the piezoelectric sensor on the needle in accordance to the ultrasound plane).
Figure 3
Figure 3
Modified Consolidated Standards of Reporting Trials flow diagram of study participants.

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Source: PubMed

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