An initial evaluation of the effect of a novel regional block needle with tip-tracking technology on the novice performance of cadaveric ultrasound-guided sciatic nerve block.

Abstract

Visibility of the needle tip is difficult to maintain during ultrasound-guided nerve block. A new needle has been developed that incorporates a piezo element 2-2.3mm from the tip, activated by ultrasound. The electrical signal manifests as a coloured circle surrounding the needle tip, and allows real-time tracking. We hypothesised that novice regional anaesthetists would perform nerve block better with the tracker turned on rather than off. Our primary objective was to evaluate the new needle by measuring the performance of novice anaesthetists conducting simulated sciatic block on the soft embalmed Thiel cadaver. Training consisted of a lecture, scanning in volunteers and practice on cadavers. Testing entailed scanning the sciatic nerve of a cadaver and conducting 20 in-plane sciatic blocks in the mid-to-upper thigh region. Subjects were randomised equally, in groups of five, according to the sequence: tracker on/off/on/off; or tracker off/on/off/on. Video recordings were assessed by six raters for steps performed correctly and errors committed. Eight subjects were recruited and 160 videos were analysed. Using the tracking needle, five correct steps improved and one error reduced. The benefits included: better identification of the needle tip before advancing the needle, OR (95%CI) 3.4 (1.6-7.7; p<0.001); better alignment of the needle to the transducer, 3.1 (1.3-8.7; p=0.009); and better visibility of the needle tip 3.0 (1.4-7.3; p=0.005). In conclusion, use of the tracker needle improved the sciatic block performance of novices on the soft embalmed cadaver.