The Jedi Grip: a novel technique for administering local anaesthetic in ultrasound‐guided regional anaesthesia

Abstract

We agree that the use of ultrasound guidance is rapidly becoming the gold standard in regional anaesthesia [1]. When using electrical stimulators for peripheral nerve location, it has been common practice for the anaesthetist to inject the local anaesthetic while the assistant controls the nerve stimulator output. During ultrasound-guided nerve blockade, we have noticed that the anaesthetist uses one hand to control the ultrasound probe and the other to position the needle tip, and the assistant delivers the local anaesthetic solution. By handing over this task, the anaesthetist loses valuable feedback from the syringe plunger, since resistance to injection might indicate an intraneural needle tip position [2]. Moreover, in contrast to the nerve stimulation technique, where a single bolus injection is typical, with ultrasound-guided nerve blockade a number of smaller boluses are often given, as the needle tip is repositioned to optimise spread of local anaesthetic around nerves. Communicating and co-ordinating a number of smaller injections can be difficult and this is a potential source of error. We now use a novel technique that allows the anaesthetist to control the ultrasound probe with one hand and then both manipulate the needle and deliver the local anaesthetic with the other. Having a single operator controlling all aspects of the block removes the risk of communication error. By maintaining control of the syringe, the anaesthetist can also continue to obtain useful feedback regarding the resistance to injection. Initially, we advance the needle as usual towards the target nerve. Once the needle tip is close to the nerve, we change over to what we call the ‘Jedi grip’. With the anaesthetist’s hand pronated, the hub of the needle is held between the middle phalanx of the index and middle fingers. We grip the local anaesthetic syringe in the palm by the ring and little fingers, leaving the thumb free to aspirate or inject (Fig. 2). The ‘Jedi grip’. We have found that this method is particularly suited to in-plane needle manipulation. It helps minimise lateral angulation and hence maintain a view of the needle. Newcomers to ultrasound-guided regional anaesthesia may also be able to decrease the volume of local anaesthetic used. It is not uncommon for learners to lose sight of the needle tip in the temporal delay between asking the assistant to inject a millilitre of local anaesthetic and its actual delivery. By taking control of the time and volume of injection, one can limit the amount given. Based on the resulting image, a decision can be taken to advance the needle or alter its direction to a more optimal position. This allows one to use smaller volume boluses than an assistant could practically inject. Often, injections of less than 0.25 ml local anaesthetic can be seen on the screen, therefore reducing the amount wasted before reaching the intended target. We propose that this technique provides a useful solution to the conundrum that ultrasound technology has created, i.e. too much gear, not enough hands.