title: Novel needle guide reduces time to perform ultrasound-guided femoral nerve catheter placement: A randomised controlled trial.
abstract: Ultrasound-guided nerve blocks have become the standard when performing regional nerve blocks in anaesthesia. Infiniti Plus (CIVCO Medical Solutions, Kalona, Iowa, USA) is a needle guide that has been recently developed to help clinicians in performing ultrasound-guided nerve blocks.
  
  
  
  We tested the hypothesis that femoral nerve catheter placement carried out with the Infiniti Plus needle guide will be quicker to perform than without the Infiniti Plus. Secondary aims were to assess whether the Infiniti Plus needle guide decreased the number of block attempts and also whether it improved needle visibility.
  
  
  
  A randomised, controlled trial.
  
  
  
  Cleveland Clinic, Cleveland, Ohio, USA.
  
  
  
  We enrolled adult patients having elective total knee arthroplasty with a femoral nerve block and femoral nerve catheter. Patients, who were pregnant or those who had preexisting neuropathy involving the surgical limb, coagulopathy, infection at the block site or allergy to local anaesthetics were excluded.
  
  
  
  Patients were randomised into two groups to receive the ultrasound-guided femoral nerve catheter placement with or without the Infiniti Plus needle guide.
  
  
  
  The time taken to place the femoral nerve catheter, the number of attempts, the success rate and needle visibility were recorded. We used an overall α of 0.05 for both the primary and secondary analyses; the secondary analyses were Bonferroni corrected to control for multiple comparisons.
  
  
  
  The median (interquartile range Q1 to Q3) time to perform the femoral nerve catheter placement was 118 (100 to 150) s with Infiniti Plus and 177 (130 to 236) s without Infiniti Plus. Infiniti Plus significantly reduced the time spent performing femoral nerve catheterisation, with estimated ratio of means [(95% confidence interval), P value] of 0.67 [(0.60 to 0.75), P < 0.001] with Infiniti Plus compared with no Infiniti Plus. However, Infiniti Plus had no effect on the odds of a successful femoral nerve catheter placement, number of attempts or percentage of perfect needle visibility.
  
  
  
  We found that the use of Infiniti Plus decreased the median time to successfully place a femoral nerve catheter by 33% compared with not using Infiniti Plus. This difference may be more apparent to clinicians undertaking this procedure less often or by those in training as our team was very experienced, had been trained in the technique and was working in a hospital with a large caseload.
  
  
  
  Clinicaltrials.gov identifier: NCT02080481.
authors.affiliation: From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA (AT), Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas and Outcomes Research Consortium (RB), Department Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA (HE, WASE, KM, EF, MS), Department of Quantitative Health Sciences and Department of Outcomes Research (NMZ) and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA (DIS).
authors.forename: Alparslan
authors.initials: A
authors.lastname: Turan
authors.forename: Rovnat
authors.initials: R
authors.lastname: Babazade
authors.forename: Hesham
authors.initials: H
authors.lastname: Elsharkawy
authors.forename: Wael Ali Sakr
authors.initials: WA
authors.lastname: Esa
authors.forename: Kamal
authors.initials: K
authors.lastname: Maheshwari
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Zimmerman
authors.forename: Loran Mounir
authors.initials: LM
authors.lastname: Soliman
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation / Q000379:methods; D001340:Autonomic Nerve Block / Q000295:instrumentation / Q000379:methods*; D002404:Catheterization / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005267:Femoral Nerve / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009339:Needles; D013997:Time Factors; D018084:Ultrasonography, Interventional / Q000295:instrumentation / Q000379:methods*