Novel needle guide reduces time to perform ultrasound-guided femoral nerve catheter placement

Alparslan Turan, Rovnat Babazade, Hesham Elsharkawy, Wael Ali Sakr Esa, Kamal Maheshwari, Ehab Farag, Nicole M. Zimmerman, Loran Mounir Soliman, Daniel I. Sessler

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background 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. OBJECTIVES 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. DESIGN A randomised, controlled trial. SETTING Cleveland Clinic, Cleveland, Ohio, USA. PATIENTS 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. INTERVENTIONS Patients were randomised into two groups to receive the ultrasound-guided femoral nerve catheter placement with or without the Infiniti Plus needle guide. MAIN OUTCOME MEASURES 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 a of 0.05 for both the primary and secondary analyses; the secondary analyses were Bonferroni corrected to control for multiple comparisons. RESULT 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. CONCLUSION 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.

Original languageEnglish (US)
Pages (from-to)135-140
Number of pages6
JournalEuropean Journal of Anaesthesiology
Volume34
Issue number3
DOIs
StatePublished - Mar 1 2017
Externally publishedYes

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Femoral Nerve
Needles
Catheters
Nerve Block
Knee Replacement Arthroplasties
Local Anesthetics
Catheterization
Hypersensitivity
Extremities
Anesthesia
Randomized Controlled Trials
Confidence Intervals

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Novel needle guide reduces time to perform ultrasound-guided femoral nerve catheter placement. / Turan, Alparslan; Babazade, Rovnat; Elsharkawy, Hesham; Esa, Wael Ali Sakr; Maheshwari, Kamal; Farag, Ehab; Zimmerman, Nicole M.; Soliman, Loran Mounir; Sessler, Daniel I.

In: European Journal of Anaesthesiology, Vol. 34, No. 3, 01.03.2017, p. 135-140.

Research output: Contribution to journalArticle

Turan, A, Babazade, R, Elsharkawy, H, Esa, WAS, Maheshwari, K, Farag, E, Zimmerman, NM, Soliman, LM & Sessler, DI 2017, 'Novel needle guide reduces time to perform ultrasound-guided femoral nerve catheter placement', European Journal of Anaesthesiology, vol. 34, no. 3, pp. 135-140. https://doi.org/10.1097/EJA.0000000000000584
Turan, Alparslan ; Babazade, Rovnat ; Elsharkawy, Hesham ; Esa, Wael Ali Sakr ; Maheshwari, Kamal ; Farag, Ehab ; Zimmerman, Nicole M. ; Soliman, Loran Mounir ; Sessler, Daniel I. / Novel needle guide reduces time to perform ultrasound-guided femoral nerve catheter placement. In: European Journal of Anaesthesiology. 2017 ; Vol. 34, No. 3. pp. 135-140.
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abstract = "Background 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. OBJECTIVES 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. DESIGN A randomised, controlled trial. SETTING Cleveland Clinic, Cleveland, Ohio, USA. PATIENTS 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. INTERVENTIONS Patients were randomised into two groups to receive the ultrasound-guided femoral nerve catheter placement with or without the Infiniti Plus needle guide. MAIN OUTCOME MEASURES 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 a of 0.05 for both the primary and secondary analyses; the secondary analyses were Bonferroni corrected to control for multiple comparisons. RESULT 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. CONCLUSION 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.",
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AU - Babazade, Rovnat

AU - Elsharkawy, Hesham

AU - Esa, Wael Ali Sakr

AU - Maheshwari, Kamal

AU - Farag, Ehab

AU - Zimmerman, Nicole M.

AU - Soliman, Loran Mounir

AU - Sessler, Daniel I.

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N2 - Background 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. OBJECTIVES 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. DESIGN A randomised, controlled trial. SETTING Cleveland Clinic, Cleveland, Ohio, USA. PATIENTS 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. INTERVENTIONS Patients were randomised into two groups to receive the ultrasound-guided femoral nerve catheter placement with or without the Infiniti Plus needle guide. MAIN OUTCOME MEASURES 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 a of 0.05 for both the primary and secondary analyses; the secondary analyses were Bonferroni corrected to control for multiple comparisons. RESULT 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. CONCLUSION 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.

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