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W2405117280 abstract "Key points•Challenges to successful ultrasound-guided regional anaesthesia include the acquisition of acceptable ultrasound images of the nerve while avoiding artifacts.•The most common ultrasound artifacts are acoustic or anatomic.•Physiological and pathological factors attributable to the patient affect image quality and interpretation.•Needle artifacts may cause confusion and error during ultrasound-guided nerve blocks.•The combination of ultrasound guidance and peripheral nerve stimulation, ‘dual guidance’, may offer reassurance when the nerve or needle image is suboptimal. •Challenges to successful ultrasound-guided regional anaesthesia include the acquisition of acceptable ultrasound images of the nerve while avoiding artifacts.•The most common ultrasound artifacts are acoustic or anatomic.•Physiological and pathological factors attributable to the patient affect image quality and interpretation.•Needle artifacts may cause confusion and error during ultrasound-guided nerve blocks.•The combination of ultrasound guidance and peripheral nerve stimulation, ‘dual guidance’, may offer reassurance when the nerve or needle image is suboptimal. Ultrasonography offers significant advantages in the practice of regional anaesthesia, including faster sensory onset and improved success rates compared with landmark-based techniques.1McCartney JL Lin L Shastri U Evidence basis for the use of ultrasound for upper-extremity blocks.Reg Anesth Pain Med. 2010; 35: S10-S15Crossref PubMed Google Scholar Adequate visualization of neural and surrounding structures together with monitoring the spread of local anaesthetic (LA) are absolute prerequisites for the safe and successful practice of ultrasound-guided regional anaesthesia (USGRA). The creation of an ultrasound (US) image is based on the physical properties of the US beam formation, propagation of sound in matter, interaction of sound with reflective interfaces, echo detection, and machine processing. However, there are often a number of significant challenges to acquiring the optimal US images necessary to achieve successful nerve blocks. Such challenges include the acquisition and interpretation of optimal US images of the target structure and needle while avoiding tissue and needle artifacts. Other difficulties may include physiological, pathological, and anatomical factors attributable to the patient and which may affect image quality and interpretation. This article will describe some of these problems, discuss strategies to avoid them, and highlight current and future advances which may assist the practice of USGRA. The spatial resolution of any imaging system is defined as its ability to distinguish two points as separate entities in space. Spatial resolution is commonly subcategorized into axial and lateral resolution.2Kremkau FW Taylor KJW Artefacts in ultrasound imaging.J Ultrasound Med. 1986; 5: 227-237Crossref PubMed Scopus (181) Google Scholar Axial resolution is defined as the US machine's ability to differentiate two objects located at different depths in the direction parallel to the direction of the US beam. If the distance between two objects is greater than half the length of the US pulse then the two objects will be distinguished. Axial resolution can be improved by increasing the US pulse frequency and reducing the pulse length. High-frequency transducers having shorter pulse lengths will therefore provide optimal axial resolution but is limited to superficial structures. When viewing deeper structures, the operator should chose a transducer with the highest frequency which permits adequate tissue penetration of the US beam. Lateral resolution refers to the ability of the US machine to differentiate two objects which are adjacent to each other, e.g. the tibial and common peroneal nerves in the popliteal fossa. The width of the US beam and depth of imaging both influence lateral resolution.2Kremkau FW Taylor KJW Artefacts in ultrasound imaging.J Ultrasound Med. 1986; 5: 227-237Crossref PubMed Scopus (181) Google Scholar All US beams typically diverge at greater depth, while wider beams diverge further in the far field. Therefore, lateral resolution is best at shallow depths and worse with deeper imaging. Lateral resolution is improved by positioning the focal zone, the narrowest part of the US beam, at the level of the target object. Temporal resolution refers to the US machine frame rate which is the speed at which an imaging device produces consecutive images and is important in real-time imaging during USGRA.3Fiegenbaum H Echocardiography. 5th Edn. Lea and Febiger, Philadelphia1993Google Scholar The rate at which consecutive image frames are generated and viewed affects the visualization of moving structures. A low frame rate may obscure motion during a procedure including probe movement, needle insertion, and the placement of LA during USGRA. Temporal resolution is influenced by the speed of sound in tissue and may be improved by decreasing the imaging depth to just below the target and minimizing tissue movement by the slow injection of LA. Artifacts are presentations on the display which are added or omitted, or are of improper location, brightness, shape, and size compared with the true anatomical features. Some artifacts are useful in interpretation, while others may cause confusion and error. A good understanding of artifacts, why they arise and how to deal with them when they occur, is important in the practice of USGRA. Failure to recognize imaging artifacts may lead to complications, including incorrect needle placement or deposition of LA in the wrong location or hazardous areas. Artifacts are commonly observed during ultrasound-guided nerve blocks and may be related either to the tissues, the block needle, or both (Table 1). The most common artifacts observed during USGRA are either acoustic or anatomic.Table 1Errors associated with ultrasound artifactsArtifactErrorAcousticPresentation of ultrasound informationAnatomic or pitfallInterpretationOptical illusionPerceptionOtherElectrical noise Open table in a new tab Acoustic artifacts are usually the result of incorrect assumptions during processing by the instrumentation. These assumptions include sound travels in straight lines; the intensity of returning echoes is directly related to scatter from the imaged object and distance of structures on the image is directly proportional to the time taken for the sound wave to return to the transducer. Some acoustic artifacts are also secondary to operator error, including improper transducer placement or scanning technique. A common operator error is a suboptimal angle of insonation resulting in a significant portion of the returning US beam being transmitted away from the transducer producing a degraded image (Fig. 1). As the incident angle of the US beam to the nerve approaches 90°, the target image becomes optimal. This artifact can be reduced by sweeping the transducer through an arc to determine the position of the transducer which provides the best available image of the target nerve. Classification of common acoustic artifacts together with their origins and imaging errors are listed in Table 2.Table 2Ultrasound artifacts and their originsAcoustic artifact groupOriginArtifactAttenuationReduced amplitude of echoes by intervening structures with high attenuationShadowingIncreased relative amplitude of echoes caused by an intervening structure of low attenuationEnhancementResolutionPulse frequencyAxial resolutionBeam divergenceLateral resolutionInterference patterns from echoes generated by closely spaced reflectorsSpecklePropagation pathSound pulse reverberates back and forth between two strong parallel reflectorsReverberationChange in direction of a sound pulse when it crosses a boundary and when a change of speed of sound occursRefractionReflection of the sound pulse from a highly reflective surfaceMirror imageSide beams from the transducer cause objects to be viewed in a lateral locationSide lobeMiscellaneousTwo closely spaced reflective surfaces and generated echoes with a conical shapeComet tail Open table in a new tab Acoustic errors may also be subdivided into missing or falsely perceived structures and are often due to errors in gain setting. Gain refers to the degree of amplification applied to all US signals returning to the transducer. Too high a gain will make the image too bright and obscure structures, while too little gain will darken the image and may make a structure appear absent. This artifact is avoided by adjusting the gain setting to permit an optimal view of the target nerve and surrounding tissues. Attenuation is the progressive loss of acoustic energy and signal strength as the US wave passes through tissue. Attenuation can be reduced by increasing the overall gain control and image brightness. Time gain compensation (TGC) is a setting applied in ultrasonography to account for tissue attenuation of the US beam. TGC independently increases the gain of reflected signals with increasing time from the transmitted pulse and is equivalent to increasing the gain of a reflected US signal with increasing tissue depth. Acoustic shadowing may also cause structures to appear less echogenic and occurs when a target lies below a structure which strongly absorbs or reflects US waves. Air and bone are common causes of acoustic shadowing during USGRA and may be avoided by changing the transducer position (Fig. 2). Acoustic enhancement occurs when an area behind a weakly attenuating structure produces stronger echoes than the surrounding structures. This artifact commonly occurs behind blood vessels and may lead to confusion with neural structures lying posterior to arteries and veins. This is particularly important when scanning the axilla where the radial nerve lies behind the axillary artery and may be confused with acoustic enhancement artifact (Fig. 3). In such instances, the use of a nerve stimulator may be helpful to confirm the presence or absence of the radial nerve. Image degradation is often the result of reverberation which results from US waves reflecting off two strong reflectors, for example, the pleura, peritoneum, or a fascial plane. The image shows multiple linear and hyperechoic areas distal to the reflecting surface (Fig. 2). The comet tail sign refers to the mergence of multiple reverberation artifacts in a tapered band adjacent to the object.4Feldman MK Katyal S Blackwood MS US artefacts.Radiographics. 2009; 29: 1179-1189Crossref PubMed Scopus (201) Google Scholar Increasing the pressure of the probe on the skin may eliminate the reverberation artifact. The ‘double-barrelled subclavian artery’ is also an example of a reverberation artifact (Fig. 4). This results from the US beam bouncing within the lumen of the subclavian artery and creating a mirror image of the subclavian artery deep to the first rib. It is important to recognize that the image of the subclavian artery under the first rib is an artifact and attempted needle insertion towards this point may lead to a pneumothorax. Anatomic artifacts are tissue structures which resemble the target nerve. These errors are also referred to as ‘pitfall errors’. Tendons and nerves may be difficult to distinguish by ultrasonography (Fig. 5). This is a particular problem in the wrist, but tracking structures proximally often assist in differentiating the two structures since tendons will integrate within their respective muscles. Blood vessels are not normally mistaken for nerves. Arteries are anechoic and pulsatile, while veins are compressible. Nerves are usually hyperechoic (echo bright) or hypoechoic (echo dark) and non-compressible. However, the roots of the brachial plexus may sometimes appear similar to a small diameter vessels. Colour Doppler is useful in identifying vascular structures but may be misleading if the transducer is placed perpendicular to the blood vessels and detection of blood flow is suboptimal. Flow detection is best when the transducer is aligned in the direction of blood flow. Inflamed lymph nodes may also be mistaken for nerves, but the former are often well circumscribed, non-compressible anechoic structures with small, hypoechoic internal features (Fig. 6). Additionally, a nerve stimulator will differentiate between a lymph node and motor nerve. Illusions may be categorized as illusions of sensation, perception, and image formation.5Klatzky RL Wu B Stetten G Spatial representations from perception and cognitive mediation.Curr Dir Psychol Sci. 2008; 17: 359-364Crossref PubMed Scopus (17) Google Scholar They represent alterations in the appearance of reality due to the process of image formation and may result in misinterpretation. Noise degrades the quality of an US image and often appears as low-amplitude echoes in echolucent areas. The origins of random noise are extensive and often include excessive gain and other changes in machine settings. A common source of noise in the operating theatre is electrocautery. Ultrasound machines are often fitted with filters to limit the amount of electrical interference. Obesity is a rapidly growing pandemic disease and regional anaesthesia offers many potential advantages to the obese patient. Airway manipulation and cardiopulmonary depression are avoided, while postoperative pain control is improved. However, peripheral and centroneuroaxis nerve block may be technically difficult in the obese patient. While US guidance has revolutionized the practice of regional anaesthesia, it has several limitations, particularly in the obese patient. Neural structures are more deeply situated in obese patients and the US beam is highly attenuated as it travels a greater distance through the tissue layers. Sound attenuation in adipose tissue is defined as the product of the attenuation coefficient (decibels per centimetre at 1 MHz), the transducer frequency (MHz), and thickness of the adipose tissue (cm).6Scanlan KA Sonographic artefacts and their origins.Am J Roentgenol. 1991; 156: 1267-1272Crossref PubMed Scopus (87) Google Scholar Adipose tissue is also associated with phased aberration of the US beam due to the uneven speed of sound within the irregularly shaped layers of adipose tissue.7Fiegler W Felix R Langer M Schultz E Fat as a factor affecting resolution in diagnostic ultrasound: possibilities for improving picture quality.Eur J Radiol. 1985; 5: 304-309PubMed Google Scholar Whenever an US beam crosses a tissue boundary, a portion of the sound energy is reflected back to the transducer creating more echoes and further artifacts including speckling and clutter which are particular problems in the obese patient. Speckling artifact refers to interference patterns from echoes generated by closely spaced reflectors and which are too small to resolve.8Guo Y Cheng HD Tian J Zhang Y A novel approach to speckle reduction in ultrasound imaging.Ultrasound Med Biol. 2009; 35: 628-640Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar The resulting US image appears to have a granular structure which obscures the underlying anatomy. Clutter artifact appears as a diffuse haze in hypoechoic areas overlying areas of interest and degrading image quality.9Lediju MU Pihl MJ Dahl JJ Trahey GE Quantitative assessment of the magnitude, impact and spatial extent of ultrasonic clutter.Ultrason Imaging. 2008; 30: 151-168Crossref PubMed Scopus (92) Google Scholar Sources of acoustic clutter include sound reverberation in tissue layers, US beam distortion, and random acoustic noise. Consequently, the acquired US image in obese patients is often suboptimal. US imaging in obese patients may be improved by using a lower frequency transducer, while the US machine should be set to ‘penetrate’ to enable greater depth penetration of the US beam at the lower frequency. Signal attenuation is reduced and more of the primary beam penetrates the subcutaneous adipose tissue. The needle should be aligned as parallel as possible to the probe by carefully choosing the entry site and by tilting the far end of the probe down (‘heel in’ manoeuvre). Harmonic imaging is a technique in ultrasonography which provides images of better quality by exploiting non-linear propagation of US through body tissues.10Desser TS Jeffrey RB Tissue harmonic imaging techniques: physical principles and clinical applications.Semin Ultrasound CT MR. 2001; 22: 1-10Abstract Full Text PDF PubMed Scopus (131) Google Scholar Distortion of the US beam leads to the generation of harmonics, multiples of the transmitted US frequency. These harmonic waves which are generated within the tissue increase with increasing depth. Near field clutter is reduced and resolution increased, thus improving image quality. Spatial compound imaging which combines overlapping image frames from different US beam angles to form a single real-time image may also assist in reducing artifacts.8Guo Y Cheng HD Tian J Zhang Y A novel approach to speckle reduction in ultrasound imaging.Ultrasound Med Biol. 2009; 35: 628-640Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar Other processing filters including speckle reduction may also improve image quality. Tissue oedema offers a number of challenges during ultrasound-guided nerve blocks. Diffuse oedema may amplify sound absorption and decrease the echo contrast that normally exists between nerves and the surrounding tissues (Fig. 6). Oedema may also compress or displace neural structures changing its anatomic position or shape. Tissue oedema is a particular problem in the ankle and may obscure the anatomy and make identification of neural structures and the observation of LA spread particularly difficult. In extreme cases, it is often necessary to choose a more proximal area where tissue oedema is less prevalent to permit effective and safe execution of the ultrasound-guided nerve block. Air forms an impenetrable barrier to sound and casts a shadowing artifact (Fig. 2). Image quality is degraded and underlying structures obscured. Air may be present secondary to a pathological process including subcutaneous emphysema but may also be due to air injection during the ultrasound-guided procedure. The presence of microbubbles in an injectate may degrade an image by reflecting the US beam, thus obscuring the target and surrounding structures (Fig. 7; Online video 1). Care should be taken to remove air bubbles before undertaking the procedure and to minimize the number of syringe changes. Additionally, pre-warmed LA may assist in reducing microbubble formation. 10.1093/bjaceaccp/mkw026video01Video 1If reading the pdf online, click on the image to view the video.View Large Image Figure ViewerDownload (PPT) Muscle atrophy due to chronic myositis and muscle degeneration in the elderly is commonly observed during USGRA. The atrophied muscles reflect the US beam and are shown as hyperechoic structures. Failure of the US beam to adequately penetrate atrophied muscle obscures deeper structures. In such circumstances, it is often unsafe to proceed and an alternative location for the ultrasound-guided nerve block should be chosen. The observation of anatomical anomalies is not uncommon during USGRA and is important to recognize. The musculocutaneous nerve is absent in 1.4–6% of the population in whom branches originate either from a common trunk arising from the median nerve or directly from the median nerve itself (Fig. 8; Online video 2).11Guerri-Guttenberg RA Ingolotti M Classifying musculocutaneous nerve variations.Clin Anat. 2009; 22: 671-683Crossref PubMed Scopus (64) Google Scholar However, the majority of anatomical abnormalities in the upper limb are related to vascular anomalies which may impact on the practice of USGRA as blood vessels are often used as landmarks for peripheral nerve blocks. Anatomical variation of the brachial artery may be observed in up to 25% of the population and includes high proximal division into the terminal branches.12Bergman RA Thompson SA Afifi AK Saadeh FA Compendium of Human Anatomic Variations. 1st Edn. Urban & Schwarzenberg, Baltimore1988Google Scholar The brachial artery is often used as a landmark for the median nerve block at the elbow, but this advantage is lost if the brachial artery has already divided. Other anatomic variants include the persistent median artery and veins which accompany the median nerve in the forearm in ∼19% and 6% of patients, respectively.13Dolan J Milligan P Persistent median artery and veins in patients undergoing elective day case hand surgery.Reg Anesth Pain Med. 2013; 38: 462-463Crossref PubMed Scopus (3) Google Scholar These vessels normally evolute and are not often noted in the adult population. When present, the needle should approach the nerve on its non-vascular aspect to avoid inadvertent vessel puncture. Another common anatomical anomaly is the superficial ulnar artery (SUA) and may be observed in up to 10% of individuals.14Gray AT Schafhalter-Zoppoth I Ultrasound guidance for ulnar nerve block in the forearm.Reg Anesth Pain Med. 2003; 28: 335-339PubMed Google Scholar While the ulnar artery usually accompanies the ulnar nerve (UN) in the distal forearm, the SUA lies superficial to the flexor muscles throughout its course and is an unreliable landmark for identification of the UN which may be difficult to distinguish from surrounding tendons. In this instance, the use of a peripheral nerve stimulator is advantageous before the deposition of LA. 10.1093/bjaceaccp/mkw026video02Video 2If reading the pdf online, click on the image to view the video.View Large Image Figure ViewerDownload (PPT) Real-time assessment of needle position is vital during USGRA. However, observation of the regional block needle and needle tip can also pose challenges during the practice of USGRA. Needles are strong reflectors of the US beam and are subject to reverberation artifacts evident as multiple linear densities behind the needle and which occur due to US waves bouncing back and forth within the lumen of the needle (Fig. 9). It is important to note that the true needle image is the one nearest the transducer. Such artifacts most commonly occur when the needle is completely perpendicular to the US beam and can therefore be reduced by decreasing the angle of the US beam to <90°. In addition, a reduction in far gain will darken the distal artifacts. A mirror artifact is a type of reverberation artifact and is produced when an object is located in front of a strong US reflector, e.g. needles and bone. A second representation of the needle is observed in an incorrect location behind the strong reflector and may cause confusion. It is important to note that the true needle image is the one nearest the transducer. Another common needle artifact is the bayonet artifact in which the needle appears broken or bent (Fig. 9). This artifact occurs because of differences in the speed of sound in different tissues which are adjacent to the needle. The speed of sound is reduced in adipose tissue compared with muscle and takes longer to return to the transducer. Therefore, a needle placed in adipose tissue will appear to be deeper than that part of the needle which is in muscle. The side lobe artifact is often seen during USGRA and may cause confusion in image interpretation.15Dolan J Baker A Side-lobe artefact observed during ultrasound-guided peripheral nerve blocks of the upper limb.Reg Anesth Pain Med. 2011; 36: 413-414Crossref PubMed Scopus (1) Google Scholar Several low-intensity beams, side lobes, are often located peripheral to the main axis of an US beam. Although they are of a much lower intensity than the main beam, these peripheral beams are sufficiently high to create significant artifacts when they interact with highly reflective acoustic surfaces, including a metallic needle path. In contrast, other US artifacts, the side lobe artifact is visible anterior to the true needle path. The artifact is divergent and diffuse while the needle tip projected beyond the true needle pathway. The side lobe artifact is a particular problem with but not unique to linear transducers and can be observed with both static and real-time equipment. The artifact is minimized by careful repositioning of the US transducer. Maintaining optimal needle visibility during the ultrasound-guided nerve block remains a significant challenge even to experienced practitioners. Needle-beam alignment may be improved by the use of a mechanical guide attached to the transducer, but needle realignment may be restricted and the freehand technique is often preferred. Needle visibility may be improved by using needle with a larger diameter but at the expense of increased tissue damage and patient discomfort. Needle tip and shaft visibility is improved by keeping the needle shaft at more than 55° to the US beam while keeping the needle tip at 0 or 180° to the US beam. Priming the needle with air or fluid does not improve needle echogenicity. The parallel contribution of US guidance and peripheral nerve stimulation (PNS) or ‘dual guidance’ may offer versatility and reassurance when localizing nerves. Although ultrasonography has the advantages of real-time imaging of nerves and monitoring the spread of LA, it also encourages multiple injections and needle realignments during ultrasound-guided nerve block. However, PNS also has some disadvantages including a reliance on eliciting a motor response which may be affected by numerous factors, including disease processes. Failed nerve block in the presence of an adequate motor response is not uncommon and may be due to the presence of fascial planes inhibiting the spread of LA and delivery of asymmetric current from the needle tip. PNS combined with ultrasonography is useful for identifying neural structures when there is doubt about the sonoanatomy and as a warning system when there is uncertainty about the position of the needle tip. Dual guidance may also be useful as an aid when learning USGRA. However, it is sometimes difficult to distinguish between intra- and extra-fascicular injection by current resolution. Triple monitoring (US, PNS, and measurement of injection pressure) has been proposed as the standard to minimize nerve injury.16Gordon J Monitoring and documentation.in: Hadzic A Hadzic's Peripheral Nerve Blocks and Anatomy for Ultrasound-Guided Regional Anesthesia. McGraw-Hill, New York2012Google Scholar US technology continues to advance. Recent advances have included additions to both needle and machine technology. Advances in needle technology to improve the reflective signal have included dimpling, roughing, scoring, and the application of a polymeric coating to the needle with the aim of increasing the return of the US signal to the transducer (Fig. 10).17Hebard S Hocking G Echogenic technology can improve needle visibility during ultrasound-guided regional anesthesia.Reg Anesth Pain Med. 2011; 36: 185-189Crossref PubMed Scopus (89) Google Scholar These needles may improve needle tip visibility when the insonation angle is steep but are of limited value in superficial ultrasound-guided blocks. Needles with piezoelectric polymer sensors at the tip have also been designed. Other approaches to improving needle visibility include beam steering technology and the use of proprietary software algorithms within the US machine software to adjust the needle-beam angle to 90°. Ultrasound characterization of tissue elasticity or elastography offers the ability to distinguish key anatomical features and differentiate between neural and extraneural tissue.18Lockwood H McLeod G The stresses and strains of ultrasound-guided regional anaesthesia.Int J Clin Anesthesiol. 2013; 1: 1007Google Scholar In recent years, technology has improved enormously in areas such as transducer sensitivity, beam formation, image processing, and final data display. Three-dimensional US offers several advantages over two-dimensional views. Multiple planes of view can be visualized providing information about the spatial relationship between structures and tracking of LA spread. However, the technology is currently limited by a slower frame rate and reduced image quality while needle visibility is not enhanced. Other recent advances include the use of metamaterials which permit US to pass through tissues with a high acoustic index including bone.19Craster RV Guenneau S Acoustic Metamaterials. 1st Edn. Springer, Dordrecht2013Crossref Google Scholar Machine recognition and automated nerve block systems may also prove useful for enhancing the accuracy of identification of peripheral nerves. The videos associated with this article can all be viewed from the article in BJA Education online. None declared The associated MCQs (to support CME/CPD activity) can be accessed at https://access.oxfordjournals.org by subscribers to BJA Education." @default.
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W2405117280 title "Challenges, solutions, and advances in ultrasound-guided regional anaesthesia" @default.
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W2405117280 cites W2024443146 @default.
W2405117280 cites W2035393245 @default.
W2405117280 cites W2040991369 @default.
W2405117280 cites W2144081420 @default.
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