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      Photoacoustic needle improves needle tip visibility during deep peripheral nerve block

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          Abstract

          We developed a novel technology using the photoacoustic effect that improve needle tip visibility. We evaluated whether this technology improves needle tip visibility when performing a deep peripheral nerve block in a cadaver model. A photoacoustic needle was developed using a conventional echogenic needle with an intraluminal optical fiber. A pulsed laser sends light from a source through the fiber, which is converted to ultrasound at the needle tip using the photoacoustic effect. A nerve block expert performed deep nerve blocks using the photoacoustic needle and the ultrasound views recorded, with or without photoacoustic ultrasound at the needle tip. Needle tip visibility was evaluated by questionnaire (Likert scale 1: very poor, 5: very good) completed by anesthesiologists evaluating recorded images. The score was presented as median [first quartile, third quartile]. Statistical analysis was performed using the Wilcoxon matched-pairs signed rank test. The scores of needle tip visibility with photoacoustic ultrasound from the needle tip (4.3 [4.0, 4.5]) was significantly higher than that without photoacoustic ultrasound (3.5 [3.2, 3.8]) (p < 0.01). Ultrasound emitted at the needle tip using the photoacoustic effect improves needle tip visibility during deep peripheral nerve blocks.

          Clinical trial number University Hospital Medical Information Network Center Clinical Trials Registration System (UMIN000036974).

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          Most cited references14

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          Ultrasound-guided regional anesthesia: how much practice do novices require before achieving competency in ultrasound needle visualization using a cadaver model.

          Ultrasound needle visualization is a fundamental skill required for competency in ultrasound-guided regional anesthesia. The primary objective of this study using a cadaver model was to quantify the number of procedures that novices need to perform before competency, using a predefined dynamic scoring system was achieved in ultrasound needle visualization skills. Fifteen trainees, novices to ultrasound-guided regional anesthesia, performed 30 simulated sciatic nerve blocks in cadavers. After each procedure, a supervisor provided feedback regarding quality-compromising behaviors. Learning curves were constructed for each individual trainee by calculating cusum statistics. Trainees were categorized into those who were proficient, not proficient, and undetermined. A mathematical model predicted the number of procedures required before an acceptable success rate would be attained. Logistic regression was used to identify factors associated with success. There was wide variability in individual cusum curves. The mean number of trials required to achieve competency in this cohort was 28. Trainees were categorized as proficient (n = 6), not proficient (n = 5), and undetermined (n = 4). With each subsequent procedure, there was a significant increase in the likelihood of success for trainees categorized as not proficient (P = 0.023) or undetermined (P = 0.024) but not for trainees categorized as proficient (P = 0.076). Participants recruited later in the study had an increased likelihood of success (P < 0.001). Trainees became competent in ultrasound needle visualization at a variable rate. This study estimates that novices would require approximately 28 supervised trials with feedback before competency in ultrasound needle visualization is achieved.
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            The American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy joint committee recommendations for education and training in ultrasound-guided regional anesthesia.

            Ultrasound-guided regional anesthesia (UGRA) is a growing area of both clinical and research interest. The following document contains the work produced by a joint committee from ASRA and the European Society of Regional Anesthesia and Pain Therapy. This joint committee was established to recommend to members and institutions the scope of practice, the teaching curriculum, and the options for implementing the medical practice of UGRA.This document specifically defines the following:1. 10 common tasks used when performing an ultrasound-guided nerve block,2. The core competencies and skill sets associated with UGRA,3. A training practice pathway for postgraduate anesthesiologists, and4. A residency-based training pathway.In both the residency and postgraduate pathways, training, competency, and proficiency requirements include both didactic and experiential components. The Joint Committee recommends that the decision to grant UGRA privileges be based at the individual institution level. Each institution that conducts UGRA is encouraged to support a productive quality improvement process.
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              Photoacoustic needle: minimally invasive guidance to biopsy.

              We introduce a needle probe based on photoacoustics (PA) to extend the scope of optical needle methods in guiding biopsies. Pulsed light is coupled to an optical fiber in a needle to be inserted in tissue, and PA signals are detected using an ultrasound imager used for needle guidance. This PA needle samples large volumes and possesses an imaging component so that sites forward and off-axis of the fiber are surveyed. This allows navigation of those regions for optical characterization and direct biopsy in a subsequent step. The concept is explored on simple phantoms and biological specimens.
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                Author and article information

                Contributors
                dg274825@cf6.so-net.ne.jp
                Journal
                Sci Rep
                Sci Rep
                Scientific Reports
                Nature Publishing Group UK (London )
                2045-2322
                19 April 2021
                19 April 2021
                2021
                : 11
                : 8432
                Affiliations
                [1 ]GRID grid.411205.3, ISNI 0000 0000 9340 2869, Department of Anesthesiology, , Kyorin University School of Medicine, ; 6-20-2 Shinkawa, Mitaka City, Tokyo 181-8611 Japan
                [2 ]GRID grid.410804.9, ISNI 0000000123090000, Department of Surgery, , Jichi Medical University, ; Shimotsuke, Tochigi Japan
                [3 ]GRID grid.410862.9, ISNI 0000 0004 1770 2279, Medical System Research & Development Center, , FUJIFILM Corporation, ; Kanagawa, Japan
                [4 ]GRID grid.411205.3, ISNI 0000 0000 9340 2869, Department of Anatomy, , Kyorin University Faculty of Medicine, ; Mitaka, Tokyo Japan
                Article
                87777
                10.1038/s41598-021-87777-9
                8055898
                33875687
                e630ee16-ce36-4079-948d-fae5d3ba3ea8
                © The Author(s) 2021

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 16 January 2021
                : 5 April 2021
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100002424, Fujifilm Corporation;
                Award ID: A Study on the Usefulness of Ultrasound-Guided Needle Tip Enhancement
                Categories
                Article
                Custom metadata
                © The Author(s) 2021

                Uncategorized
                nervous system,neurology,risk factors
                Uncategorized
                nervous system, neurology, risk factors

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