title: [Improvement of sonographic visualization of cannula needle tips by alignment of the needle lumen : In vitro investigation of established needle tip forms].
abstract: In the context of ultrasound-guided peripheral nerve blocks (regional anesthesia), clear visualization of the needle tip and the target structure are mandatory for the performance of a safe puncture and injection. The purpose of this in vitro study was to analyze the visualization of different forms of needle tips and calibers of cannulas in a phantom simulating human tissue, with the help of a standardized image analysis system. Different depths and angles of the puncture needle in relation to the ultrasound probe were tested.
  
  
  
  Cannula needles established for use in regional anesthesia with different surfaces, diameters and needle tip form in 23 different combinations were analyzed. A gelatine-based phantom was used to simulate human tissue. The standardized visualization of the needle tip with the ultrasound probe was performed in plane at different angles (30°, 45° and 60°), depths of penetration (1 cm, 2 cm and 3 cm) and two different alignments of the cannula needle lumen to the ultrasound probe (0° and 180°). The screenshots of the ultrasound pictures were analyzed by quantifying the pixel brightness around the needle tip (region of interest) with a standardized software (score 0-255).
  
  
  
  In this study 1104 ultrasound images of cannula needles were analyzed. Diminished scores (reduced pixel brightness) of the needle tips were documented with increasing distance from the ultrasound probe. Comparison of punctures at angles of 30° and 45° showed no differences in needle tip visibility (same scores) but punctures at an angle of 60° were poorly visualized compared with 30° and 45° (mean scores 87.90 ± 11.60 vs. 78.40 ± 12.07, p < 0.001 and 81.85 ± 11.79 vs. 78.40 ± 12.07, p < 0.001, respectively). The direct alignment of the cannula lumen towards the ultrasound probe (0°) was significantly more easily visualized when compared with the reverse alignment of 180° (mean scores 86.90 ± 12.74 vs. 84.80 ± 11.66, p = 0.003, respectively). No differences in visibility were detected between the different cannula needle diameters examined. The Sprotte cannula showed the best visibility score with respect to the cut of the needle tip (mean score 89.40 ± 11.72).
  
  
  
  The visibility of cannulas in ultrasound scans depends on the ultrasound frequency, angle of the puncture in relation to the ultrasound probe and the depth of penetration. The results of this study showed that direct alignment of the cannula needle lumen towards the ultrasound probe (0°) independently improved needle tip visualization. This simple measure allows a significant improvement in the safe performance of ultrasound-guided peripheral nerve blocks.
authors.affiliation: Klinik für Anaesthesiologie und Intensivmedizin, Klinikum Neumarkt, Kliniken des Landkreises Neumarkt i.d.OPf., Nürnberger Str. 12, 92318, Neumarkt i.d.OPf., Deutschland. Ulrich.Schwemmer@klinikum.neumarkt.de.
authors.forename: U
authors.initials: U
authors.lastname: Schwemmer
authors.affiliation: Klinik für innere Medizin, SLK Klinikum am Plattenwald, Bad Friedrichshall, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Geppert
authors.affiliation: Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Marburg, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Steinfeldt
authors.affiliation: Klinik und Poliklinik für Anaesthesiologie, Uniklinik Würzburg, Würzburg, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Wunder
keywords: Anesthesia, regional; Equipment design; Gelatine; Needles; Phantoms, imaging