The Use of a New Device-Assisted Needle Guidance versus Conventional Approach to Perform Ultrasound Guided Brachial Plexus Blockade: A Randomized Controlled Study

Amaresh Vydyanathan,1 Priya Agrawal,2 Naveen Shetty,3 Singh Nair,1 Nancy Shilian,4 Naum Shaparin1 1Department of Anesthesiology and Pain Management, Montefiore Medical Center, Bronx, NY, USA; 2Sutter Health System, Oakland, CA, USA; 3Department of Anesthesiology, New York University, New York, NY, USA; 4Department of Family Medicine, Mount Sinai South Nassau Hospital, Oceanside, NY, USACorrespondence: Amaresh Vydyanathan, 1250 Waters Place, Tower II, 8th Floor, Bronx, NY, USA, Tel +216-702-5965, Fax +929-263-3950, Email avydyana@montefiore.orgPurpose: Ultrasound guidance during nerve blockade poses the challenge of maintaining in-plane alignment of the needle tip. The needle guidance device maintains needle alignment and assists with in-plane needle visualization. The purpose of this study is to evaluate the utility of this device by comparing procedure performance during brachial plexus blockade with the conventional approach.Methods: After the Institutional Review Board approval and obtaining informed consent, 70 patients receiving either interscalene or supraclavicular nerve blocks were randomly assigned into 2 groups, a conventional approach versus utilizing the needle guidance device. An independent observer recorded: total procedure time; needle insertion time; number of unplanned redirections; and number of reinsertions. Additionally, physician satisfaction and ease of needle visualization were assessed.Results: Data from seventy patients were analyzed. The median [25th percentile-75th percentile] time to complete the block by the device assisted needle guidance group was 3 (2– 3.75) minutes and 4 (3– 6) minutes in the conventional approach group (p < 0.001). Additionally, subgroup analyses were performed in the supraclavicular block and interscalene block. Supraclavicular blockade, needle insertion time (median [25th percentile-75th percentile] in seconds) (106 [92– 162] vs 197 [140– 278]), total procedure time (3 [2– 3] vs 4.5 [4– 6] in minutes) and unplanned needle redirections (2 [1– 5] vs 5.5 [3– 9]) were significantly lower in needle guidance group (p < 0.001). With interscalene blockade, needle insertion time (86 [76– 146] vs 126 [94– 295]) and unplanned needle redirections (2 [1– 3] vs 4 [2– 8.5]) were significantly lower with needle guidance (p < 0.001), but total procedure time was similar. All the physicians reported that they would use the needle guidance again, and 90% would prefer it for in-plane blocks.Conclusion: Performing regional blocks using the needle guidance device reduces needle insertion time and unplanned needle redirections in brachial plexus blockade. Moreover, physician satisfaction also improved compared to the use of the conventional technique.Keywords: brachial plexus blockade, ultrasound guidance, peripheral nerve blockade, needle guidance, needle visualizatio