Landmark-guided Technique Research Articles

Superficial parasternal intercostal plane block: Anatomical landmark-guided technique.

Superficial parasternal intercostal plane block: Anatomical landmark-guided technique.

Comparing the Efficacy of Landmark-Based Fascia Iliaca Compartment Block and Pericapsular Nerve Group Block for Preoperative Positioning and Postoperative Analgesia in Patients Undergoing Surgery for Hip Fractures: A Randomized Controlled Trial.

Subarachnoid block is the most common anesthetic technique for patients having corrective hip surgeries. However, adequate positioning for a successful subarachnoid block is a major challenge in this particular population of patients, owing to the site of fracture. Regional anesthesia, in the form of nerve blocks, is an effective means of alleviating such constraints and gives an added benefit of prolonged postoperative analgesia. The pericapsular nerve group (PENG) block and the fascia iliaca compartment block (FICB), under ultrasonography guidance, are a few examples of the commonly performed peripheral nerve blocks in such settings. However, the landmark-based techniques of nerve blockade still hold good in many resource poor settings, given the lack of ultrasonography facilities. To compare the ease of spinal positioning using the patient sitting satisfaction score between the landmark-guided FICBand PENG block. This study was done on 80 patients of the American Society of Anesthesiology (ASA) grade I or II with intertrochantericfractures of the hip joint scheduled for proximal femoral nailing. Patients were allocated into two groups of 40 each through computer generated random numbers, to receive 30 ml of 0.5% ropivacaine via the landmark-guided technique of FICB in Group F and peripheral nerve stimulator assisted landmark-guided PENG block in Group P, 30 minutes prior to spinal positioning. Time to passive leg raise (PLR) to 15 degrees and time to PLR to 30 degrees with a standard goniometer guidance at visual analogue scale (VAS) score < 4 and ease of spinal positioning through the sitting satisfaction score at the 30th minute were assessed. Any adverse effects and events of failure were noted. The duration of postoperative analgesia was measured through the time to the first dose of paracetamol on arrival at the post-anesthesia care unit. Statistical analysis was done using JASP version (0.18.3.0) using the independent samples t-test and significance was taken when p value was < 0.001. The time to PLR to 15 degrees and 30 degrees were achieved faster in the patients who received the PENG block in comparison to the patients who received the FICB, and the average patient sitting satisfaction score was significantly higher in Group P as compared to Group F (p < 0.001). While the overall amount of analgesics used in both groups was similar, the overall period of postoperative analgesia was prolonged in Group F compared to Group P (p < 0.001). The landmark guided PENG block is feasible and superior to the landmark-guided FICB for preoperative positioning and analgesia. The FICB provides a longer duration of postoperative analgesia for patients with intertrochanteric fractures.

O24: Triggering Change: Evaluating Minimally Invasive Techniques in the Pandemic-Era Hand Surgery in Malaysia

Abstract Aims This study aimed to compare outcomes of open surgical release versus ultrasound-guided and anatomical landmark-guided percutaneous release techniques for trigger finger treatment during the COVID-19 pandemic (year 2020-2022) at a single centre in Malaysia. Methods A retrospective review was conducted for 44 patients (94 digits) who underwent open surgical release (OS, n=52 digits), ultrasound-guided percutaneous release (UPR, n=30 digits), or anatomical landmark-guided percutaneous release (APR, n=12 digits) for trigger finger from 2020-2022. Outcomes assessed included post-operative pain, triggering recurrence, time to return to work/activities, patient satisfaction, and complications. Results Patients undergoing percutaneous release had expedited return to work/activities (3 days) compared to open surgery (20 days) (p&amp;lt;0.0001). No UPR/APR patients reported persistent pain at 3 months versus 13.5% of OS patients. Recurrence rates were comparable between modalities (1.9% vs 2.4%). Patient satisfaction was similar across OS/UPR/APR groups (4.4 vs 4.3 vs 4.4). Complication risks were lower with percutaneous techniques. Conclusions During the COVID-19 pandemic, percutaneous trigger finger release facilitated swifter rehabilitation and reduced hospital visits versus open surgery. The percutaneous approaches demonstrated clear benefits especially relevant for strained healthcare systems, including neater post-operative recovery, diminished long-term discomfort, and lower complication risks. Percutaneous release has considerable advantages and merits wider embrace.

Ultrasound-assisted Upper Thoracic Epidural Anaesthesia in Awake Breast Surgeries: A Case Series

Carcinoma of the breast is a leading cause of hospitalisation in elderly women and the most common surgery performed in Surgical Oncology and General Surgery Departments. Traditionally, General Anaesthesia (GA) was used for patients undergoing modified radical mastectomy. However, GA is not an ideal choice for patients with restrictive pulmonary diseases, obesity, or Chronic Obstructive Pulmonary Disease (COPD), as it is associated with increased intraoperative and postoperative complications. Regional anaesthesia is a suitable alternative, as it has the advantages of reduced sympathetic stimulation, no airway manipulation, and avoids polypharmacy, thereby reducing the hospital stay. A series of 10 female patients were presented, who were scheduled for modified radical mastectomy surgery under ultrasound-assisted thoracic epidural anaesthesia, and the patients were awake and conscious throughout the surgery. The ultrasound-assisted upper thoracic epidural was performed with a 100% success rate, and the mean procedure time taken was 238.5 seconds (ultrasound examination plus needle placement). Out of the 10 patients, one patient had two needle punctures. The needle redirections were absent in three patients, two times in three patients, and one time in four patients. Except for one patient, the epidural was successfully placed on the first attempt. Patient comfort was assessed based on the Modified Comfort Scale, with Grade-1 in five patients, Grade-2 in four patients and Grade-3 in one patient. No complications such as dural puncture or bloody tap were reported. In patients scheduled for modified radical mastectomy, performing an upper thoracic epidural using a landmark-guided technique is challenging, as the thoracic spines are very acutely angulated (T3-T6). Therefore, the ultrasound-assisted thoracic epidural technique is a safe and effective bedside tool that can be used to identify the epidural space without any side effects for the patients.

Comparison of Serratus Anterior Plane Block by Anatomical Landmark-Guided Technique Versus Ultrasound-guided Technique for Gynaecomastia Surgery: A Randomized Controlled Trial

Background: Breast surgeries are common surgical procedures and postoperative pain after mastectomy is a major concern as inadequate pain relief can result in chronic pain and reduced quality of life. Serratus anterior plane (SAP) block is suitable for perioperative analgesia for gynaecomastia correction surgery. Objectives: To compare postoperative pain relief using the VAS and D-VAS scores between anatomical landmark-guided SAP block and ultrasound-guided SAP block in patients undergoing surgery for gynecomastia correction. Methods: Patients aged 16-40 years, belonging to American Society of Anaesthesiologists (ASA) physical status I or II who were scheduled for gynaecomastia correction surgery were randomized and allocated into two groups. Group I (n = 15) patients received 20 ml of 0.25 % bupivacaine solution with 20 μg of Fentanyl by anatomical landmark-guided SAP technique while Group II (n = 15) patients in the control group received same drug using ultrasound-guidance technique. VAS and D-VAS from arrival to post anaesthesia care unit (PACU), then after 30 minutes, and at 1 hour, 2 hours, 6 hours, 12 hours, 18 hours, and 24 hours. Results: Both groups had comparable results in terms of pain scores at different time intervals, duration of analgesia (615 mins vs 706 mins) and need for rescue analgesics. Conclusion: Anatomical landmark-based SAP block technique is comparable to the ultrasound-guided SAP block technique in terms of efficacy and duration of analgesia with lesser complications. The former can serve as an alternative to the latter technique in resource-limited countries.

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial.

Effective pain control during reduction of shoulder dislocation is essential for patient comfort. However, there is a lack of comprehensive research comparing the efficacy of different pain management techniques, specifically landmark-guided and ultrasound-guided intra-articular analgesic injections. Among patients undergoing closed reduction of a shoulder dislocation, were there differences between an intra-articular shoulder injection placed using anatomic landmarks and an ultrasound-guided intra-articular injection in terms of (1) pain before versus after the injection and pain before injection versus after the reduction, or (2) length of stay in the emergency department and complications of the procedure? Between August 2021 and March 2023, 28 patients with anterior shoulder dislocation were treated at the emergency department of a tertiary referral care center. They were randomly assigned to either the landmark-guided or ultrasound-guided intra-articular lidocaine injection group. Differences in pain levels between preinjection and postinjection, preinjection and postreduction, length of hospital stay, and complications were assessed and compared between the two groups. Patients were followed for 2 weeks. There were no between-group differences in terms of age, gender, baseline pain score, and any other relevant factors. There were no differences between the groups in terms of pain reduction between preinjection and postinjection (landmark-guided: ΔVAS 2.8 ± 1.1, ultrasound-guided: ΔVAS 2.9 ± 1.0, mean difference -0.14 [95% confidence interval -0.97 to 0.68]; p = 0.72) or between preinjection and postreduction (landmark-guided: ΔVAS 6.6 ± 2.1, ultrasound-guided: ΔVAS 5.8 ± 1.8, mean difference 0.79 [95% CI -0.74 to 2.31]; p = 0.30). There were no differences in length of stay in the emergency department (landmark-guided: 162 ± 38 minutes, ultrasound-guided: 184 ± 73 minutes, mean difference 22 minutes [95% CI -67 to 24]; p = 0.33), and no complications were reported in either group during the 2-week follow-up period. The results of the landmark-guided technique were not different from those of ultrasound-guided injection in terms of lower pain levels, length of stay, and complications. These findings provide valuable guidance for orthopaedic surgeons, enabling them to make informed decisions based on their expertise and available resources. Level I, therapeutic study.

Effectiveness of Ultrasound-guided versus Landmark-based Glucocorticoid Injection in the Treatment of First Carpometacarpal Joint Osteoarthritis

Background: Osteoarthritis is a debilitating degenerative disease more pronounced in elderly affecting many joints. The first carpometacarpal joint (CMC1) is commonly affected. Pain is the major complaint, which can impact patient’s daily activities. Intra-articular glucocorticoid injection can be considered if conservative measures fail and ultrasound guided injection might be superior to the traditional anatomic landmark-guided technique. Objective: The aim of this study is to evaluate the effectiveness of ultrasound-guided versus landmark-based approach to intra-articular CMC1 injection using the Australian Canadian osteoarthritis hand index (AUSCAN). Methods: Adult patients diagnosed with symptomatic CMC1 osteoarthritis who failed conservative measures were enrolled. In this prospective observational cohort study, utilizing a convenience sample, intra-articular corticosteroid injection was administered either by ultrasound-guided technique or landmark-based approach. Pain, stiffness and function in 10-points scale at baseline, 6 and 12 weeks were collected and analyzed using descriptive analysis. Results: There were 33 patients enrolled. Mean age was 63 years, with females making up the majority of participants (n = 28, 84.8%). Mean duration of CMC1 pain was 10 months (SD=2.5) up to the point of receiving the injection. Ultrasound guided injection was performed in 60.6% (n=20), while 39.4% (n=13) had the landmark approach. Both groups achieved a statistically and clinically significant level of change in AUSCAN score at week 6 (P≤ 0.05) but with a recurrence of symptoms at week 12 (P ≤ 0.05). At both intervals the AUSCAN scores were better than baseline (P ≤ 0.05). There was no difference between the two groups regarding baseline pain VAS score (mean ultrasound group= 6.6 vs landmark group= 7.5; P = 0.18). No significant differences were identified between two groups in terms of changes from baseline to 6, 12 and between 6 to 12 weeks in pain, stiffness and hand function (P &gt; 0.05). Conclusion: No difference was found between the ultrasound-guided and landmark-based approaches for CMC1 injection on pain score, stiffness, or function.

Geometric, landmark-guided technique reduces tissue trauma, surgery time, and subjective difficulty for canine peripheral lymphadenectomies: an educational crossover study.

To compare the effect of a geometric, landmark-guided lymphadenectomy (LL) approach to peripheral lymph nodes (LNs) on successful LN identification, surgical time, tissue trauma, and ease of LN identification compared to standard lymphadenectomy (SL) and methylene blue-guided lymphadenectomy (MBL). 18 adult, mixed-breed canine cadavers operated on by 7 veterinarians and 5 fourth-year veterinary students between July 23 and October 12, 2022. Participants were provided standardized, publicly available materials regarding the anatomy and surgical techniques for SL of 3 peripheral lymphocentrums: superficial cervical, axillary (ALN), and superficial inguinal (SILN). Participants performed the 3 SLs unilaterally on canine cadavers. Thereafter, they were randomly assigned to 2 crossover groups: MBL and LL. All dissections were separated by at least 2 weeks for each participant. Primary outcome measures included successful LN identification, surgical time, tissue trauma scores, and subjective difficulty. Successful LN identification was highest with LL (86%) compared to SL (69%) and MBL (67%). Subjective difficulty scores were reduced with LL for SILN dissections. Tissue trauma scores were reduced when using LL for ALN and SILN compared to MBL and SL. Time to LN identification was reduced for ALN with LL. No significant differences were observed between MBL and SL, or for the superficial cervical dissections. Peripheral lymphadenectomies are time consuming and difficult for veterinarians in early stages of surgical training. Little surgical guidance is provided within current literature. Geometric, landmark-guided lymphadenectomies may improve LN identification success and reduce surgical time, tissue trauma, and procedure difficulty, which could encourage their clinical application.

Peripheral nerve stimulation for the treatment of chronic knee pain

The average age of our population is increasing, resulting in a high incidence of chronic degenerative knee pathologies. Several treatment options, including surgical procedures are available to help mitigate these pathologies. However, the percentage of subjects with chronic post-surgical knee pain is still estimated at 16–20%. Neuromodulation techniques such as spinal cord stimulation and dorsal root ganglion stimulation (DRGS) are treatment options for subjects with chronic knee pain. The evidence for peripheral nerve stimulation (PNS) is minimal due to a limited number of neuromodulation systems capable of targeting the distal part of the lower limbs. This study aimed to investigate the safety and efficacy externally powered PNS systems for the treatment of chronic intractable knee pain targeting the saphenous nerve. Patients suffering from chronic intractable post-surgical knee pain received landmark-guided peripheral nerve stimulation of the branches of the saphenous nerve. All implants were performed with an externally powered PNS system to avoid lead migration as a result of cross-joint lead positions tunneling towards an Implantable Pulse Generator to the trunk. Data were collected retrospectively. Subject-reported outcome was measured via numerical rating scale values on a 10-point scale measuring pain intensity at rest and in motion. Additional data were collected for the subjects treated at the Charité location, including quality of life with the SF-36 form, quality of sleep with the Pittsburgh Sleep Quality Index and mood states with the short form of the General Depression Scale. Thirty-three patients received direct to permanent implant, landmark-guided peripheral nerve stimulation of the saphenous nerve branches. Six (18.2%) subjects reported non-sufficient initial benefit from the therapy and were explanted. Two subjects were explanted due to wound infections. The total study population reported included 25 patients. These subjects reported significant improvements related to pain, quality of life, mood quality, and quality of sleep. Additionally, subjects were able to reduce their opioid medication significantly after PNS therapy. Externally powered PNS at the saphenous nerve branches is a straightforward, selective and safe technique for patients with chronic knee pain. The landmark-guided implantation technique is less invasive than classical neuromodulation techniques such as spinal cord or DRGS and complication rates remain low. Short-term results are promising and show considerable reductions in pain scores and opioid intake. Long-term results are pending.

US Guided vs Landmark Guided in Paramedian Spinal in Elderly

Abstract Background The ultrasound-assisted paramedian technique reduces the technical difficulty of spinal anaesthesia in the elderly. Compared with the landmark-guided paramedian technique, the use of ultrasound reduced the number of needle manipulations required for success, increased the firstattempt success rate and reduced block-associated pain and discomfort. Aim of the Work The study aims to evaluate whether ultrasound assisted paramedian spinal anaesthesia in the elderly can achieve successful dural puncture with fewer needle passes compared with the conventional landmark guided paramedian technique. Patients and Methods After obtaining approval from the Research Ethical Committee of Faculty of Medicine, Ain shams University; this study conducted in the operating theatres of Ain Shams University Hospitals with sample size of 10 patients / group will be needed. The patients randomly divided pre-operatively into two groups using their computer-generated random numbers such that „even numbers‟ will be enrolled in “group-L” for patients receive spinal anaesthesia by the paramedian approach by landmark guided palpation and „odd numbers‟ will be enrolled in “group-s” for patients ultrasound assisted approach. Results Ultrasonography might improve the efficacy of spinal anaesthesia by improving the accuracy of identification of intervertebral level, depth measurement of the intrathecal space and location of the interlaminar window that permits needle passage compared with the landmark guided technique, ultrasound assisted spinal anaesthesia decreases the number of puncture attempts and improves the success rate at the first attempt in patients with potential technical difficulties we believe that individualisation is a key element of minimising technical difficulties. Because of the large intersubject variability in anatomy, the blind technique have a theoretical upper limit of success rate. Through which we obtained success rates of 90 and 100% at the first attempt and within two attempts, respectively, in the ultrasound group. Conclusion Ultrasound-assisted paramedian spinal anaesthesia significantly reduces the number of needle manipulations required for success, increases the success rate at first pass and decreases periprocedural pain and patient discomfort compared with the landmark-guided paramedian technique in the elderly. Our results suggest that the neuraxial ultrasonography enhances the efficacy and comfort of spinal anaesthesia in the elderly.

Landmark-guided versus Real-time Ultrasound-guided Combined Spinal-epidural Anesthesia Techniques: Paramedian Sagittal Oblique and Transverse Interlaminar Approach.

There are different types of real-time ultrasound (US)-guided combined spinal epidural (CSE) anesthesia techniques. We aimed to investigate the effect of real-time US-guided paramedian sagittal oblique (PSO), transverse interlaminar (TI) approach method, and landmark-guided (LG) CSE anesthesia. Ninety patients who underwent CSE block were included in the study. Patients were randomized into LG (n = 30), PSO (n = 30), and TI (n = 30) groups. The primary outcome was number of needle manipulations. The secondary outcomes are the number of attempts, needle visibility, procedure time, procedure success rate, catheter placement difficulty, posterior complex distance, and complications. The number of needle manipulations was statistically significantly lower in the LG technique group (P < 0.000). When the number of attempts, the difficulty of catheter placement, and the procedure's success rate were compared between the three groups, we did not find a statistically significant difference (P > 0.05). In addition, when the procedure times were compared, the time measured for the LG group was statistically significantly lower than in the PSO and TI groups (P < 0.000). In the results of this study, the real-time US-guided CSE anesthesia application had a similar success and complication level with LG technique. The LG method had a shorter processing time and fewer needle manipulations.

Revisiting the Anatomical Landmark-Guided Central Venous Access Device Insertion: A Retrospective Cohort Study.

Ultrasound (USG) guidance is superior to blind and open cut-down techniques for accurate puncture of the internal jugular vein (IJV) or subclavian vein, but it increases the cost and duration of the procedure. Here, we report our experience with the reliability and consistency of anatomic landmark-guided technique for Central Venous Access Device (CVAD) insertion in a low-resource setting. A retrospective analysis of the prospectively maintained database of patients undergoing CVAD insertion through one of the jugular veins was performed. Central venous access was achieved using a standardized anatomic insertion landmark (apex of Sedillot's triangle). Ultrasonography (USG) and/or fluoroscopy assistance was taken as and when required. Over 12months (October 2021 to September 2022), a total of 208 patients underwent CVAD insertion. Central venous access was successfully achieved using anatomic landmark-guided technique in all but 14 patients (6.7%), in whom USG guidance or C-arm was used. Eleven out of 14 patients who needed guidance for CVAD insertion had body mass index (BMI) of more than 25, one had thyromegaly while the remaining two had an arterial puncture during cannulation. CVAD insertion-related complications included deep vein thrombosis (DVT) in five, extravasation of chemotherapeutic agent in one, spontaneous extrusion related to a fall in one, and persistent withdrawal-related occlusion in seven patients. Anatomical landmark-guided technique of CVAD insertion is safe and reliable, and can reduce the need for USG/C-arm in 93% of the patients.

Real-time ultrasound-guided versus landmark-guided subclavian vein catheterization in the intensive care unit: a prospective randomized study

Abstract Background The subclavian vein (SCV) is an alternative to the internal jugular vein when it is difficult to locate, such as in patients with hypovolemia or obesity. Ultrasonography (USG) guidance for SVC cannulation has evolved, resulting in fewer complications and higher first-pass success rates. This study aimed to compare the effectiveness and safety of SCV cannulation with USG- and landmark-guided techniques. Methods In this prospective randomized interventional controlled study, 80 patients admitted to the intensive care unit between July 2022 and October 2022 were randomly assigned to the landmark method group (LM group) and USG group. In the LM group, SCV cannulation was performed using the traditional landmark technique, whereas in the USG group, it was performed using USG guidance. The primary objective of this study was to evaluate the ease of subclavian central venous cannulation in critically ill patients using the 2 techniques. The secondary objectives were to compare the success rate of cannulation between these 2 techniques, evaluate the number of attempts, assess cannulation failure, and assess mechanical complications. Results The first-pass success rates were 70% and 92.5% in the LM and USG groups, respectively (P &lt; 0.001). The average numbers of attempts in the LM and USG groups were 1.275 (±0.520) and 1.075 (±0.266), respectively (P = 0.034). The average procedure durations were 7.45 (±1.10) and 8 (±0.933) minutes in the LM and USG groups (P = 0.018), respectively. The rates of complications in both groups were not statistically significant. Conclusion The USG guidance for SCV cannulation has an advantage over landmark-guided methods in a critical care setting. The SCV is a good alternative to internal jugular vein cannulation. The average time to cannulation was longer in the USG group than in the LM group, which can decrease with the frequent use of USG and increasing operator experience. Clinical trials This study was registered in the Clinical Trials Registry-India (CTRI Trial No. CTRI/2022/07/043694, dated May 7, 2022).

Ultrasound-guided Musculoskeletal Interventional Procedures Around the Hip: A Practical Guide.

Several studies have shown that ultrasound guidance may contribute to improved safety, effectiveness and accuracy of musculoskeletal interventional procedures performed around the hip if compared to those performed with a landmark-guided technique. Different approaches and injectates can be used for treating hip musculoskeletal disorders. These procedures may involve injections in the hip joint, periarticular bursae, tendons, and peripheral nerves. Intra-articular hip injections are mostly used as a conservative approach for treating patients affected by hip osteoarthritis. Ultrasound-guided injection of the iliopsoas bursa is performed in patients with bursitis and/or tendinopathy, to treat those with painful prosthesis due to iliopsoas impingement, or when the lidocaine test is indicated to identify the iliopsoas as a source of pain. Ultrasound-guided interventions are routinely used in patients with greater trochanteric pain syndrome having as target the gluteus medius/minimus tendons and/or the trochanteric bursae. Ultrasound-guided fenestration and platelet-rich plasma injection are applied in patients with hamstring tendinopathy with good clinical outcomes. Last but not least, ultrasound-guided perineural injections can be used for peripheral neuropathies or blocks of the sciatic, lateral femoral cutaneous, and pudendal nerves. In this paper, we discuss the evidence and technical tips for musculoskeletal interventional procedures performed around the hip, highlighting the added value of ultrasound as an imaging guidance modality.

A comparison of two techniques of internal jugular vein cannulation: Landmark-guided technique versus ultrasound-guided technique

A comparison of two techniques of internal jugular vein cannulation: Landmark-guided technique versus ultrasound-guided technique

Comparison of Ultrasound-Guided Ankle Block Versus Anatomical Landmark-Guided Ankle Block in Ankle and Foot Surgery Under Regional Anesthesia

Background: As more patients undergo foot and ankle surgery, regional anesthesia's significance in postoperative treatment has grown. Anesthesiologists and pain specialists have adopted regional anesthesia in large numbers. Numerous techniques, such as nerve stimulation, anatomical markers, and ultrasonography, have been used to block the saphenous nerve. Objective: The present study aimed to assess the traditional anatomic landmark-guided approaches in lower limb surgery performed under regional anesthesia with ultrasound-guided ankle blocks in surgical anesthetic methods. Method: This randomized control study is carried out at the hospital. A total of 60 participants with scheduled foot and ankle surgery were randomly divided into two study groups (each n=30), Ultrasound-guided ankle block (USG) and anatomical landmark-guided ankle block (ALG). Results: Recruited participants had a mean age of 50.2± 14.02, with 39 (65%) male and 21( 35%) female. A total of 49 patients (82%) were able to undergo anesthesia successfully, with 26 (86.60%) of those patients belonging to the USG block group and 23 (76.60%) of those patients belonging to the ALG block group undergoing anesthesia successfully (p-value = &gt;0.999). Practical implication: This study will help to comprehend either ultrasound-guided ankle block or anatomical landmark-guided ankle block in foot surgeries give better results. Conclusion: The results of this research indicate that the success rates of the two procedures are statistically insignificantly different; however, the USG ankle block for surgical anesthesia performed under regional anesthetic had a greater success rate than the anatomic landmark-guided technique. Keywords: Foot surgery, USG ankle block, anesthesia, ALG Block, postoperative treatment

Incidence of catheter-related bloodstream infections following ultrasound-guided central venous catheterization: a systematic review and meta-analysis

BackgroundUltrasonographic guidance is widely used for central venous catheterization. Several studies have revealed that ultrasound-guided central venous catheterization increases the rate of success during the first attempt and reduces the procedural duration when compared to the anatomical landmark-guided insertion technique, which could result in protection from infectious complications. However, the effect of ultrasound-guided central venous catheterization on catheter-related bloodstream infections remains unclear. We aimed to conduct a systematic review and meta-analysis to evaluate the value of ultrasound guidance in preventing catheter-related bloodstream infections and catheter colonization associated with central venous catheterization.MethodsThe Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE (via PubMed) were searched up to May 9, 2022 for randomized controlled trials (RCTs) comparing ultrasound-guided and anatomical landmark-guided insertion techniques for central venous catheterization. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs. A meta-analysis was performed for catheter-related bloodstream infections and catheter colonization, as primary and secondary outcomes, respectively.ResultsFour RCTs involving 1268 patients met the inclusion criteria and were analyzed. Ultrasound-guided central venous catheterization was associated with a slightly lower incidence of catheter-related bloodstream infections (risk ratio, 0.46; 95% confidence interval [CI], 0.16–1.32) and was not associated with a lower incidence of catheter colonization (risk ratio, 1.36; 95% CI, 0.57–3.26).ConclusionUltrasound-guided central venous catheterization might reduce the incidence of catheter-related bloodstream infections. Additional RCTs are necessary to further evaluate the value of ultrasound guidance in preventing catheter-related bloodstream infections with central venous catheterization.

Ultrasound-assisted subarachnoid block in a patient with severe kyphosis

Here, we report a case of ultrasound-assisted subarachnoid block in a patient with severe kyphosis. A 69-year-old man was scheduled for metal removal from hip screws. He had a previous experience with subarachnoid block using the landmark-guided technique, but it was very difficult due to severe kyphosis. However, we could easily determine the correct needle insertion point using ultrasound imaging and performed a successful dural puncture on the first attempt. This case demonstrates the clinical usefulness of ultrasound imaging for subarachnoid blocks in patients with severe kyphosis.

Comparison of knee arthrocentesis first-attempt success between Ultrasound-Guided, Ultrasound-Localised and Landmark-Guided techniques in the novice: A crossover study with random order of events.

To compare knee arthrocentesis first-attempt success using landmark-guided, ultrasound-localised and ultrasound-guided techniques when performed by third-year medical students. In this prospective, crossover study with randomised order of events, medical students performed three different arthrocentesis techniques on knee models: landmark-guided, ultrasound-localised and ultrasound-guided. Each subject attempted the techniques in a randomly assigned permutation at both high- and low-volume simulated knee effusions. The data were analysed with general estimating equations, which produced odds ratios comparing first-attempt success between different techniques at all effusion volumes. Ninety four of 111 third-year medical students were enrolled. Proportions of first-attempt success for the landmark-guided, US-localised and US-guided were 72%, 86% and 75%, respectively. For all effusion volumes, US-localised demonstrated a statistically significant increase in first-attempt success over the landmark-guided technique, OR = 2.38 (95% CI: 1.52-3.70). There was a greater increase in first-attempt success at low-volume effusions, OR = 2.86 (95% CI: 1.47-5.56), but no significant increase at high-volume effusions: OR = 1.85 (95% CI: 1.00-3.45). For all effusion volumes, US-guided demonstrated no difference to first-attempt success compared with landmark, OR = 1.15 (95% CI: 0.71-1.85). At low-volume effusions, US-guided demonstrated a statistically significant increase in first-attempt success over landmark-guided, OR = 2.17 (95% CI: 1.10-4.35), with no significant difference at high volumes, OR: 0.55 (95% CI: 0.28-1.06). The data presented here suggest that in this simulated knee model of arthrocentesis, ultrasound-guided approaches tend to have best efficacy at lower volume effusions, while ultrasound localized tends to do best at higher volume effusions, and both tended to perform better than the landmark technique. This study specifically looked at novices to both arthrocentesis and ultrasound, so extrapolating these results to other groups would require more study, but suggests that ultrasound incorporation into arthrocentesis benefits may offer some benefits for success rates and first attempt success. In simulated knee arthrocentesis, ultrasound-guided techniques increased first-attempt success over landmark-guided techniques among medical students. This increase was most evident for arthrocentesis of smaller volume effusions.

Comparison of landmark-guided and ultrasound-guided technique for superior laryngeal nerve block to aid fibreoptic intubation - An observational study.

Awake fibreoptic intubation (AFOI) is the gold standard in the management of the difficult airway. Several methods to achieve airway anesthesia to aid AFOI include superior laryngeal nerve block (SLNB). This study aimed to compare land-mark-guided and ultrasound-guided techniques for SLNB to aid AFOI. This was a prospective, observational study. Patients in both groups received 1 mg Midazolam and 50 μg of fentanyl for mild sedation before intubation, nasal passages were anaesthetized using lignocaine-coated nasopharyngeal airways, nebulization of 3 ml of 2% lignocaine, and intratracheal injection of 2 ml of 2% lignocaine given through cricothyroid membrane. Patients in Group L received SNLB, at the lateral end of the thyrohyoid membrane (2 ml of 1.5% lignocaine). Patients in Group U had their thyrohyoid membrane visualized using linear ultrasound probe (8 - 13 Hz) and the injection was placed just superficial to the membrane using out of plane method. The groups were compared with respect to quality of anesthesia (assessed on a 5-point scale), patient comfort during AFOI, time taken to intubation and Haemodynamics. A total of 25 patients were enrolled: 13 in Group L and 12 patients in Group U. The demographics were comparable. Quality of airway anesthesia, time taken to intubation, haemodynamics and patient comfort were comparable. All were intubated successfully and there were no complications. USG-guided SLNB was comparable to landmark-based method with respect to quality of airway anesthesia and patient comfort. USG-guided block did not add any advantage over the landmark-based method.