Translation of sonoelastography from Thiel cadaver to patients for peripheral nerve blocks

S. Munirama, A. R. Satapathy, A. Schwab, R. Eisma, G. A. Corner, S. Cochran, R. Soames, G. A. McLeod

    Research output: Contribution to journalArticle

    17 Citations (Scopus)

    Abstract

    Ultrasound guidance is now common in regional anaesthesia practice, but remains limited by poor visibility of the needle tip and poor quantification of local anaesthetic spread. Sonoelastography based on tissue compression is a technique depicting tissue strain. Hitherto used largely for tumour diagnosis, we used it in both Thiel embalmed cadavers and two patients receiving interscalene and femoral blocks to observe changes in tissue strain during local anaesthetic injection. The primary aim of our study was to measure the area under the curve (weighted for time) of the strain pattern in Thiel perineural tissue when using a range of volumes of embalming fluid (0.25, 0.5, 1, 2.5, 5 and 7.5 ml) for interscalene and femoral blocks using sonoelastography. Our secondary aims were to evaluate static images of anatomy and videos of needle insertion and perineural injection using combined B-Mode ultrasound and sonoelastography. Independent raters assessed the anatomy and spread using a 7-point Likert scale, ranked from extremely poor to extremely good. We performed 83 blocks in cadavers. Concordance between both raters was good, with weighted Kappa (95% CI) 0.66 (0.610.71). The characteristics of spread were similar with both interscalene and femoral block; spread increased with injectate volume up to 1 ml. Analysis of variance showed differences in spread between injection volumes (p = 0.009), but not between regional blocks (p = 0.05). Post-hoc analysis showed greater spread with 1 and 2.5 ml volumes compared with 0.25 ml. In patients, visibility of strain during injection was better with sonoelastography than with B-Mode ultrasound and showed a dose response from 1 to 5 ml volumes of local anaesthetic. Colour strain recognition using sonoelastography offers the ability to differentiate between nerve and surrounding tissue during local anaesthetic injection by improving visibility of spread (p = 0.04).

    Original languageEnglish
    Pages (from-to)721-728
    Number of pages8
    JournalAnaesthesia
    Volume67
    Issue number7
    DOIs
    Publication statusPublished - Jul 2012

    Keywords

    • Aged
    • Aged, 80 and over
    • Anesthetics, Local
    • Brachial Plexus
    • Cadaver
    • Dose-Response Relationship, Drug
    • Elasticity Imaging Techniques
    • Embalming
    • Female
    • Femoral Nerve
    • Humans
    • Male
    • Middle Aged
    • Nerve Block
    • Spinal Nerve Roots
    • Ultrasonography, Interventional

    Cite this

    Munirama, S. ; Satapathy, A. R. ; Schwab, A. ; Eisma, R. ; Corner, G. A. ; Cochran, S. ; Soames, R. ; McLeod, G. A. / Translation of sonoelastography from Thiel cadaver to patients for peripheral nerve blocks. In: Anaesthesia. 2012 ; Vol. 67, No. 7. pp. 721-728.
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    abstract = "Ultrasound guidance is now common in regional anaesthesia practice, but remains limited by poor visibility of the needle tip and poor quantification of local anaesthetic spread. Sonoelastography based on tissue compression is a technique depicting tissue strain. Hitherto used largely for tumour diagnosis, we used it in both Thiel embalmed cadavers and two patients receiving interscalene and femoral blocks to observe changes in tissue strain during local anaesthetic injection. The primary aim of our study was to measure the area under the curve (weighted for time) of the strain pattern in Thiel perineural tissue when using a range of volumes of embalming fluid (0.25, 0.5, 1, 2.5, 5 and 7.5 ml) for interscalene and femoral blocks using sonoelastography. Our secondary aims were to evaluate static images of anatomy and videos of needle insertion and perineural injection using combined B-Mode ultrasound and sonoelastography. Independent raters assessed the anatomy and spread using a 7-point Likert scale, ranked from extremely poor to extremely good. We performed 83 blocks in cadavers. Concordance between both raters was good, with weighted Kappa (95{\%} CI) 0.66 (0.610.71). The characteristics of spread were similar with both interscalene and femoral block; spread increased with injectate volume up to 1 ml. Analysis of variance showed differences in spread between injection volumes (p = 0.009), but not between regional blocks (p = 0.05). Post-hoc analysis showed greater spread with 1 and 2.5 ml volumes compared with 0.25 ml. In patients, visibility of strain during injection was better with sonoelastography than with B-Mode ultrasound and showed a dose response from 1 to 5 ml volumes of local anaesthetic. Colour strain recognition using sonoelastography offers the ability to differentiate between nerve and surrounding tissue during local anaesthetic injection by improving visibility of spread (p = 0.04).",
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    Munirama, S, Satapathy, AR, Schwab, A, Eisma, R, Corner, GA, Cochran, S, Soames, R & McLeod, GA 2012, 'Translation of sonoelastography from Thiel cadaver to patients for peripheral nerve blocks', Anaesthesia, vol. 67, no. 7, pp. 721-728. https://doi.org/10.1111/j.1365-2044.2012.07086.x

    Translation of sonoelastography from Thiel cadaver to patients for peripheral nerve blocks. / Munirama, S.; Satapathy, A. R.; Schwab, A.; Eisma, R.; Corner, G. A.; Cochran, S.; Soames, R.; McLeod, G. A.

    In: Anaesthesia, Vol. 67, No. 7, 07.2012, p. 721-728.

    Research output: Contribution to journalArticle

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    T1 - Translation of sonoelastography from Thiel cadaver to patients for peripheral nerve blocks

    AU - Munirama, S.

    AU - Satapathy, A. R.

    AU - Schwab, A.

    AU - Eisma, R.

    AU - Corner, G. A.

    AU - Cochran, S.

    AU - Soames, R.

    AU - McLeod, G. A.

    N1 - Anaesthesia © 2012 The Association of Anaesthetists of Great Britain and Ireland.

    PY - 2012/7

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    N2 - Ultrasound guidance is now common in regional anaesthesia practice, but remains limited by poor visibility of the needle tip and poor quantification of local anaesthetic spread. Sonoelastography based on tissue compression is a technique depicting tissue strain. Hitherto used largely for tumour diagnosis, we used it in both Thiel embalmed cadavers and two patients receiving interscalene and femoral blocks to observe changes in tissue strain during local anaesthetic injection. The primary aim of our study was to measure the area under the curve (weighted for time) of the strain pattern in Thiel perineural tissue when using a range of volumes of embalming fluid (0.25, 0.5, 1, 2.5, 5 and 7.5 ml) for interscalene and femoral blocks using sonoelastography. Our secondary aims were to evaluate static images of anatomy and videos of needle insertion and perineural injection using combined B-Mode ultrasound and sonoelastography. Independent raters assessed the anatomy and spread using a 7-point Likert scale, ranked from extremely poor to extremely good. We performed 83 blocks in cadavers. Concordance between both raters was good, with weighted Kappa (95% CI) 0.66 (0.610.71). The characteristics of spread were similar with both interscalene and femoral block; spread increased with injectate volume up to 1 ml. Analysis of variance showed differences in spread between injection volumes (p = 0.009), but not between regional blocks (p = 0.05). Post-hoc analysis showed greater spread with 1 and 2.5 ml volumes compared with 0.25 ml. In patients, visibility of strain during injection was better with sonoelastography than with B-Mode ultrasound and showed a dose response from 1 to 5 ml volumes of local anaesthetic. Colour strain recognition using sonoelastography offers the ability to differentiate between nerve and surrounding tissue during local anaesthetic injection by improving visibility of spread (p = 0.04).

    AB - Ultrasound guidance is now common in regional anaesthesia practice, but remains limited by poor visibility of the needle tip and poor quantification of local anaesthetic spread. Sonoelastography based on tissue compression is a technique depicting tissue strain. Hitherto used largely for tumour diagnosis, we used it in both Thiel embalmed cadavers and two patients receiving interscalene and femoral blocks to observe changes in tissue strain during local anaesthetic injection. The primary aim of our study was to measure the area under the curve (weighted for time) of the strain pattern in Thiel perineural tissue when using a range of volumes of embalming fluid (0.25, 0.5, 1, 2.5, 5 and 7.5 ml) for interscalene and femoral blocks using sonoelastography. Our secondary aims were to evaluate static images of anatomy and videos of needle insertion and perineural injection using combined B-Mode ultrasound and sonoelastography. Independent raters assessed the anatomy and spread using a 7-point Likert scale, ranked from extremely poor to extremely good. We performed 83 blocks in cadavers. Concordance between both raters was good, with weighted Kappa (95% CI) 0.66 (0.610.71). The characteristics of spread were similar with both interscalene and femoral block; spread increased with injectate volume up to 1 ml. Analysis of variance showed differences in spread between injection volumes (p = 0.009), but not between regional blocks (p = 0.05). Post-hoc analysis showed greater spread with 1 and 2.5 ml volumes compared with 0.25 ml. In patients, visibility of strain during injection was better with sonoelastography than with B-Mode ultrasound and showed a dose response from 1 to 5 ml volumes of local anaesthetic. Colour strain recognition using sonoelastography offers the ability to differentiate between nerve and surrounding tissue during local anaesthetic injection by improving visibility of spread (p = 0.04).

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    KW - Cadaver

    KW - Dose-Response Relationship, Drug

    KW - Elasticity Imaging Techniques

    KW - Embalming

    KW - Female

    KW - Femoral Nerve

    KW - Humans

    KW - Male

    KW - Middle Aged

    KW - Nerve Block

    KW - Spinal Nerve Roots

    KW - Ultrasonography, Interventional

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    Munirama S, Satapathy AR, Schwab A, Eisma R, Corner GA, Cochran S et al. Translation of sonoelastography from Thiel cadaver to patients for peripheral nerve blocks. Anaesthesia. 2012 Jul;67(7):721-728. https://doi.org/10.1111/j.1365-2044.2012.07086.x