Mechanical needle guidance for ultrasound-guided parasagittal oblique in-plane paravertebral blocks: a cadaveric study
Orientação mecânica da agulha para bloqueios paravertebrais parasagitais oblíquos em plano guiados por ultrassom: um estudo cadavérico
Hesham Elsharkawy, Ece Yamak Altinpulluk, Tetsuya Shimada, Ilker Ince, Guangmei Mao, Nicolas Mario Mas D. Alessandro, Loran Mounir Soliman, Nair Harsha, Marta Kelava, Richard Drake, Xuan Pu, Daniel I. Sessler, Alparslan Turan
Abstract
Background
Paravertebral blocks provide analgesia for a range of thoracoabdominal surgeries. However, visualizing the needle tip during the procedure can be challenging, especially for clinicians with limited experience, because the target is deep. We therefore tested the primary hypothesis that needle guidance by the Infiniti Plus system improves ultrasound visualization of the needle tip during thoracic paravertebral blocks performed by novice residents.
Methods
Nineteen clinical anesthesia residents each performed 20 bilateral ultrasound-guided thoracic paravertebral blocks (T2−T11) on 17 unembalmed cadavers, with and without the use of a fixed-angle mechanical needle guide in a randomized crossover design. The primary outcome, percent perfect needle visibility, was compared between guided and unguided methods using a paired t-test. Secondary outcomes, including time to needle visualization, number of needle insertion attempts, and subjective ease-of-use ratings, were analyzed using paired ttests and Wilcoxon signed-rank tests, respectively. Inter-rater reliability for overall perception ratings was assessed using the Intraclass Correlation Coefficient (ICC).
Results
There were no significant differences in needle-target visualization (62% § 17% with guidance vs. 64% § 18% without, p = 0.15), time to target (HR = 1.00 [95% CI 0.86−1.16],
p = 0.99), procedural difficulty scores, or number of insertion attempts between guided and unguided blocks.
Conclusion
The Infiniti Plus mechanical needle guide did not demonstrate improved ultrasound needle tip visualization during thoracic paravertebral blocks performed by novice clinicians in
cadavers.
Keywords
Resumo
Introdução
Os bloqueios paravertebrais fornecem analgesia para diversas cirurgias toracoabdominais. No entanto, visualizar a ponta da agulha durante o procedimento pode ser desafiador, especialmente para clínicos com experiência limitada, porque o alvo é profundo. Portanto, testamos a hipótese primária de que a orientação mecânica da agulha pelo sistema Infiniti Plus melhora a visualização ultrassonográfica da ponta da agulha durante bloqueios paravertebrais torácicos realizados por residentes iniciantes.
Métodos
Dezenove residentes de anestesiologia realizaram, cada um, 20 bloqueios paravertebrais torácicos bilaterais guiados por ultrassom (T2–T11) em 17 cadáveres não embalsamados, com e sem o uso de um guia mecânico de agulha com ângulo fixo, em um desenho cruzado randomizado. O desfecho primário, porcentagem de visibilidade perfeita da agulha, foi comparado entre os métodos guiado e não guiado usando teste t pareado. Os desfechos secundários, incluindo tempo até a visualização da agulha, número de tentativas de inserção e avaliações subjetivas de facilidade de uso, foram analisados com testes t pareados e testes de postos sinalizados de Wilcoxon, respectivamente. A confiabilidade entre avaliadores para as classificações de percepção geral foi avaliada usando o Intraclass Correlation Coefficient (ICC).
Resultados
Não houve diferenças significativas na visualização agulha-alvo (62% ± 17% com guia vs. 64% ± 18% sem guia, p = 0,15), no tempo até o alvo (HR = 1,00 [CI 95% 0,86–1,16], p = 0,99), nas pontuações de dificuldade do procedimento ou no número de tentativas de inserção entre os bloqueios guiados e não guiados.
Conclusion
O guia mecânico de agulha Infiniti Plus não demonstrou melhora na visualização ultrassonográfica da ponta da agulha durante bloqueios paravertebrais torácicos realizados por clínicos iniciantes em cadáveres.
Palavras-chave
Referencias
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Submitted date:
02/04/2025
Accepted date:
08/10/2025
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