Avoid Common Errors in Ultrasound Anesthesia Needles

Avoid Common Errors in Ultrasound Anesthesia Needles

The use of point-of-care ultrasound (POCUS) has become a ubiquitous part of the anesthesiologist’s practice.ultrasound anesthesia needle In fact, many residency programs now require a course in POCUS for anesthesia residents. Many anesthesiologists and certified registered nurse anesthetists (CRNAs) are using the technology to aid in musculoskeletal and soft tissue procedures.1 However, anesthesia providers must be aware of limitations of this tool and avoid committing common errors in ultrasound-guided regional nerve blocks, which can lead to complications, such as unintentional needle movement or incorrect identification of the anatomic structures.

The most commonly made error in performing a peripheral interscalene block (SIP) involves failing to visualize the needle before advancing it.ultrasound anesthesia needle This is often due to the shadowing effect of a non-planar surface, which can be seen as an echogenic shadow on the ultrasound image. A non-planar surface may also scatter the ultrasound waves, making it difficult to distinguish the needle tip from surrounding tissue.

This problem can be avoided by ensuring the ultrasound transducer is positioned on a flat plane with respect to the needle’s long axis of travel. It is also important to continuously monitor the ultrasound image throughout the injection for evidence of local anesthetic spread. Failure to see such spread can suggest the needle is erroneously placed into a vessel, resulting in a vascular injury.2

Another problem encountered in this procedure is the resistance of tough fascial planes to needle advance. These tough planes can “tent” and inadvertently redirect the needle, particularly when approached at a shallow angle. Temporarily steepening the needle angle can help to overcome this challenge.

Finally, it is important to always pass the ultrasound anesthesia needle through a layer of sterile ultrasound gel before penetrating skin. Failure to do so can carry macroscopic amounts of gel into tissues or around nerves, which can cause a delay in the injection or interfere with proper placement of the needle.

The first step of the SAPB is to identify the carotid artery and internal jugular vein. After that, the anesthesiologist should slide the transducer lateral until the sternocleidomastoid muscle is identified, which lies superficially to the anterior scalene muscle. The anesthesiologist should then insert the needle at a 45-degree angle, aiming toward the corner pocket between the first and second rib. Injection into the plexus should be delivered at this location, and a subsequent injection at the base of the sternocleidomastoid should push the plexus up to allow for accurate needle tip positioning.

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