Real-Time Ultrasound/MRI Fusion for Suprasacral Parallel Shift Approach to Lumbosacral Plexus Blockade and Analysis of Injectate Spread: An Exploratory Randomized Controlled Trial
Jennie Maria Christin Strid, Erik Morre Pedersen, Sinan Naseer Hussain Al-Karradi, Mathias Alrø Fichtner Bendtsen, Siska Bjørn, Mette Dam, Morten Daugaard, Martin Sejr Hansen, Katrine Danker Linnet, Jens Børglum, Kjeld Søballe, Thomas Fichtner Bendtsen, Jennie Maria Christin Strid, Erik Morre Pedersen, Sinan Naseer Hussain Al-Karradi, Mathias Alrø Fichtner Bendtsen, Siska Bjørn, Mette Dam, Morten Daugaard, Martin Sejr Hansen, Katrine Danker Linnet, Jens Børglum, Kjeld Søballe, Thomas Fichtner Bendtsen
Abstract
Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21-36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; p = 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552-1023] versus 196 [167-228], p < 0.001 and 333 [254-439] versus 216 [176-294], p = 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).
Conflict of interest statement
None of the authors have any potential conflicts of interests to declare.
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References
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