title: Real-Time Ultrasound/MRI Fusion for Suprasacral Parallel Shift Approach to Lumbosacral Plexus Blockade and Analysis of Injectate Spread: An Exploratory Randomized Controlled Trial.
abstract: Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21-36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%];p= 1.00). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552-1023] versus 196 [167-228],p< 0.001 and 333 [254-439] versus 216 [176-294],p= 0.001). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).
authors.affiliation: Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
authors.forename: Jennie Maria Christin
authors.identifier: 0000-0001-8285-2140
authors.initials: JM
authors.lastname: Strid
authors.affiliation: Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
authors.forename: Erik Morre
authors.initials: EM
authors.lastname: Pedersen
authors.affiliation: Department of Biomedicine, Faculty of Health, Aarhus University, Vennelyst Boulevard 4, 8000 Aarhus C, Denmark.
authors.forename: Sinan Naseer Hussain
authors.initials: SN
authors.lastname: Al-Karradi
authors.affiliation: Medical Science, Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus C, Denmark.
authors.forename: Mathias Alrø Fichtner
authors.initials: MA
authors.lastname: Bendtsen
authors.affiliation: Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark; Medical Science, Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus C, Denmark.
authors.forename: Siska
authors.initials: S
authors.lastname: Bjørn
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000 Roskilde, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Dam
authors.affiliation: Department of Anesthesiology, Regional Hospital of Viborg, Heibergs Alle 4, 8800 Viborg, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Daugaard
authors.affiliation: Medical Science, Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus C, Denmark.
authors.forename: Martin Sejr
authors.initials: MS
authors.lastname: Hansen
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Slagelse Hospital, Ingemannsvej 18, 4200 Slagelse, Denmark.
authors.forename: Katrine Danker
authors.initials: KD
authors.lastname: Linnet
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000 Roskilde, Denmark.
authors.forename: Jens
authors.identifier: 0000-0002-9839-3812
authors.initials: J
authors.lastname: Børglum
authors.affiliation: Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark.
authors.forename: Kjeld
authors.initials: K
authors.lastname: Søballe
authors.affiliation: Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
authors.forename: Thomas Fichtner
authors.identifier: 0000-0001-5800-386X
authors.initials: TF
authors.lastname: Bendtsen
mesh_terms: D000328:Adult; D000779:Anesthetics, Local; D065527:Brachial Plexus Block / Q000379:methods; D004824:Epidural Space / Q000187:drug effects; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D008160:Lumbosacral Plexus / Q000187:drug effects* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009407:Nerve Block / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D000779:Anesthetics, Local; D008012:Lidocaine; D004837:Epinephrine