Two-Dimensional Mapping to Assess Direction and Magnitude of Needle Tip Error in Ultrasound-Guided Regional Anaesthesia

We assessed whether echogenic needles reduce tip location error, by comparing three echogenic designs (Pajunk Sonoplex, Lifetech, B. Braun Stimuplex D+) with a non-echogenic control (Pajunk Uniplex), using a novel assessment technique in unembalmed human cadavers. Multiple images were taken of each needle at shallow (15 to 25°), moderate (35 to 45°) and steep (55 to 65°) insertion angles. Twenty anaesthetists with varied experience in ultrasound-guided nerve blocks identified needle tip position and stated their confidence level in estimates. Actual tip position was determined at the time of image generation but concealed from the anaesthetists. Two-dimensional mapping of ‘tip-error’ involved measurement of the distance and orientation of each clinician's estimate of tip position in relation to the actual tip position. There were no significant differences in confidence or overall needle visibility at shallow insertion angles. At steeper angles, the Sonoplex showed significantly higher confidence and visibility scores. The remaining echogenic designs did not show any significant differences from the non-echogenic control. Objective measurements of tip error followed the same pattern as the subjective data, although were not universally significant. Two-dimensional mapping showed that as needle visibility deteriorated, so precise tip location was lost but the needle shaft/insertion path remained well-identified. As visibility deteriorated further, accuracy in this axis was also lost. When inaccurate, clinicians generally assessed the needle tip to be more superficial and inserted less far than it actually was. This has important implications for the safety of ultrasound-guided regional anaesthesia. Effective echogenic needle technology has the potential to address these concerns.