Needle Visualization in Ultrasound-Guided Regional Anesthesia: Challenges and Solutions

&NA; Needle visualization is important for safe and successful ultrasound‐guided peripheral nerve block. However, accurate and consistent visualization of the needle tip can be difficult to achieve. This review article describes many of the challenges affecting needle visualization, summarizes the relevant literature on ultrasound imaging of needles, and offers practical strategies for improving needle tip visibility. Finally, future directions for research and development are suggested.

[1]  David C. Warltier,et al.  Ultrasound-guided Regional Anesthesia Current State of the Art , 2006 .

[2]  Thomas Grau,et al.  Ultrasound Characteristics of Needles for Regional Anesthesia , 2007, Regional Anesthesia & Pain Medicine.

[3]  B. Tsui,et al.  Facilitating Needle Alignment In-Plane to an Ultrasound Beam Using a Portable Laser Unit , 2006, Regional Anesthesia & Pain Medicine.

[4]  Mathias Cohnen,et al.  Improvement of sonographic needle visibility in cirrhotic livers during transjugular intrahepatic portosystemic stent-shunt procedures with use of real-time compound imaging. , 2003, Journal of vascular and interventional radiology : JVIR.

[5]  J. Bilbao,et al.  Percutaneous vascular and nonvascular puncture under US guidance: role of color Doppler imaging. , 1994, Radiographics : a review publication of the Radiological Society of North America, Inc.

[6]  Stephen W. Smith,et al.  Piezoelectric Vibrating Needle and Catheter for Enhancing Ultrasound-Guided Peripheral Nerve Blocks , 2007, Anesthesia and analgesia.

[7]  Brian D Sites,et al.  Characterizing Novice Behavior Associated With Learning Ultrasound-Guided Peripheral Regional Anesthesia , 2006, Regional Anesthesia & Pain Medicine.

[8]  E. Buonocore,et al.  Steerable real-time sonographically guided needle biopsy. , 1981, AJR. American journal of roentgenology.

[9]  M. Bradley,et al.  In-vitro visualization of biopsy needles with ultrasound: a comparative study of standard and echogenic needles using an ultrasound phantom. , 2001, Clinical radiology.

[10]  D. Rubens,et al.  Coating agent permits improved visualization of biopsy needles during sonography. , 1998, AJR. American journal of roentgenology.

[11]  S. Ganapathy,et al.  Use of ultrasound guidance and contrast enhancement: a study of continuous infraclavicular brachial plexus approach * , 2008, Acta anaesthesiologica Scandinavica.

[12]  Rory Wolfe,et al.  Sonographically guided biopsy of focal lesions: a comparison of freehand and probe-guided techniques using a phantom. , 2005, AJR. American journal of roentgenology.

[13]  M. Bradley,et al.  An in-vitro study to understand successful free-hand ultrasound guided intervention. , 2001, Clinical radiology.

[14]  Color Doppler ultrasonographic detection of a vibrating needle system , 1997, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[15]  Robert Rohling,et al.  Enhancement of needle visibility in ultrasound-guided percutaneous procedures. , 2004, Ultrasound in medicine & biology.

[16]  Erik K Paulson,et al.  Echogenic polymer coating: does it improve needle visualization in sonographically guided biopsy? , 2002, AJR. American journal of roentgenology.

[17]  Charles E McCulloch,et al.  Ultrasound visibility of needles used for regional nerve block: an in vitro study , 2004, Regional Anesthesia & Pain Medicine.

[18]  N. Juul,et al.  Optimal set-up for ultrasound guided punctures using new scanner applications: an in-vitro study. , 2002, European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology.

[19]  E Y Yeung,et al.  US guidance of interventional procedures. , 1990, Radiology.

[20]  C. Heneghan,et al.  Levels of Evidence , 2006 .

[21]  W. Culp,et al.  Changes in ultrasonographic echogenicity and visibility of needles with changes in angles of insonation. , 2003, Journal of vascular and interventional radiology : JVIR.

[22]  R C Nelson,et al.  Sonography: the undiscovered jewel of interventional radiology. , 1996, Radiographics : a review publication of the Radiological Society of North America, Inc.

[23]  Heon Han,et al.  A Steerable Guiding Device: The New Method in Ultrasound Guidance , 2002, Investigative radiology.

[24]  S. Ganapathy,et al.  Dextrose 5% in water: fluid medium for maintaining electrical stimulation of peripheral nerves during stimulating catheter placement , 2005, Acta anaesthesiologica Scandinavica.

[25]  G. Dodd,et al.  Efficacy of sonography as a guidance technique for biopsy of abdominal, pelvic, and retroperitoneal lymph nodes. , 1996, AJR. American journal of roentgenology.

[26]  J. Swenson,et al.  A novel approach for assessing catheter position after ultrasound-guided placement of continuous interscalene block. , 2008, Anesthesia and analgesia.

[27]  T. Matalon,et al.  The pump maneuver: an atraumatic adjunct to enhance US needle tip localization. , 1990, Radiology.

[28]  A. Bodenham,et al.  Visualisation of needle position using ultrasonography , 2006, Anaesthesia.

[29]  Brian D Sites,et al.  Artifacts and Pitfall Errors Associated With Ultrasound-Guided Regional Anesthesia: Part I: Understanding the Basic Principles of Ultrasound Physics and Machine Operations , 2007, Regional Anesthesia & Pain Medicine.

[30]  D. Davis,et al.  Treated Needles , 2003, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[31]  S. Salcudean,et al.  Needle tip localization using stylet vibration. , 2006, Ultrasound in medicine & biology.

[32]  T Hatada,et al.  Ultrasound-Guided Fine-Needle Aspiration Biopsy for Breast Tumors: Needle Guide versus Freehand Technique , 1999, Tumori.

[33]  N Ragavendra,et al.  A new electronically enhanced biopsy system: value in improving needle-tip visibility during sonographically guided interventional procedures. , 1992, AJR. American journal of roentgenology.

[34]  B. Tsui,et al.  Needle Puncture Site and a “Walkdown” Approach for Short-Axis Alignment During Ultrasound-Guided Blocks , 2006, Regional Anesthesia & Pain Medicine.

[35]  N. Bedforth,et al.  Three-Dimensional, Multiplanar, Ultrasound-Guided, Radial Nerve Block , 2007, Regional Anesthesia & Pain Medicine.

[36]  M. Barrington,et al.  Investigation of a New Echogenic Needle for use with Ultrasound Peripheral Nerve Blocks , 2007, Anaesthesia and intensive care.

[37]  M. Reid,et al.  Real-time sonographic needle biopsy guide. , 1983, AJR. American journal of roentgenology.

[38]  B B Goldberg,et al.  Use of needle-vibrating device and color Doppler imaging for sonographically guided invasive procedures. , 1997, AJR. American journal of roentgenology.

[39]  J Kreula,et al.  Needle tip echogenicity. A study with real time ultrasound. , 1989, Investigative radiology.

[40]  U Mödder,et al.  [Real-time compound imaging: improved visibility of puncture needles and localization wires as compared to single-line ultrasonography]. , 2001, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[41]  Peter Marhofer,et al.  Ultrasound-guided regional anesthesia: current concepts and future trends. , 2007, Anesthesia and analgesia.

[42]  B. Tsui,et al.  The electrophysiological effect of dextrose 5% in water on single-shot peripheral nerve stimulation. , 2005, Anesthesia and analgesia.

[43]  M S Soo,et al.  Sonographically guided percutaneous interventions of the breast using a steerable ultrasound beam. , 1999, AJR. American journal of roentgenology.

[44]  U. Hamper,et al.  Improved needle-tip visualization by color Doppler sonography. , 1991, AJR. American journal of roentgenology.

[45]  Real-time Compound imaging: Verbesserte Erkennbarkeit von Punktionsnadeln und Markierungsdrähten gegenüber Single-line- Ultraschall? , 2001 .

[46]  T C McCowan,et al.  Relative ultrasonographic echogenicity of standard, dimpled, and polymeric-coated needles. , 2000, Journal of vascular and interventional radiology : JVIR.

[47]  J D Thomas,et al.  Localization of needle tip with color doppler during pericardiocentesis: In vitro validation and initial clinical application. , 2001, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[48]  K. Torp,et al.  Real-time three-dimensional ultrasound for continuous popliteal blockade: a case report and image description. , 2007, Anesthesia and analgesia.

[49]  S. Holland,et al.  Doppler US. Part I. Basic principles, instrumentation, and pitfalls. , 1990, Radiology.

[50]  Amina Barhdadi,et al.  Contribution of Tissue Harmonic Imaging and Frequency Compound Imaging in Interventional Breast Sonography , 2006, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[51]  I. Kronzon,et al.  Microbubble formation: In vitro and in vivo observation , 1982, Journal of clinical ultrasound : JCU.