Ergonomics in ultrasound-guided nerve blocks
Keywords:
Ultrasonography, Nerve block, Human engineering, Analgesia, Anesthesia
Abstract
Introduction: Performing ultrasound-guided nerve blocks has proven to be safe, but ergonomic considerations are essential.
Methods: A non-systematic literature search was conducted in the Medline/Pubmed and Embase databases.
Objective: To describe the influence of operator position, monitor location, and hand position in performing ultrasound-guided nerve blocks.
Results: Poor ergonomics is a key factor of error when performing nerve blocks under ultrasound guidance. "In-plane" needle insertion increases success. An inappropriate position may be a cause of muscle-skeletal disorders. Based on these results, we propose specific element location and operator position for the performance of certain nerve blocks.
Conclusion: Performing ultrasound-guided nerve blocks requires an ergonomic work area allowing for greater comfort and effectiveness, thus reducing the occurrence of muscle-skeletal disorders.
References
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2. Choquet O, Abbal B, Capdevila X. The new technological trends in ultrasound-guided regional anesthesia. Curr Opin Anaesthesiol. 2013;26:605-12.
3. Onishi E, Yamauchi M. The trends of ultrasound-guided neuraxial block. Masui. 2014;63:1011-7.
4. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth. 2010;104:538-46.
5. Horlocker TT, Wedel DJ. Ultrasound-guided regional anaesthesia: the search for the holy grail. Anesth Analg. 2007;104:1009-11.
6. McCartney CJ, Dickinson V, Dubrowski A, Riazi S, McHardy P, Awad IT. Ultrasound provides a reliable test of local anesthetic spread. Reg Anesth Pain Med. 2010;35:361-3.
7. Salinas FV, Hanson NA. Evidence-based medicine for ultrasound-guided regional anesthesia. Anesthesiol Clin. 2014;32:771-87.
8. Gelfand HJ, Ouanes JP, Lesley MR, Ko PS, Murphy JD, Sumida SM, Isaac GR, Kumar K, Wu CL. Analgesic efficacy of ultrasound-guided regional anesthesia: a meta-analysis. J Clin Anesth. 2011;23:90-6. [ Links ]
9. Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med. 2008;33:253-8. [ Links ]
10. Liu SS, Zayas VM, Gordon MA, Beathe JC, Maalouf DB, Paroli L, et al. A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesth Analg. 2009;109:265-71. [ Links ]
11. Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg. 2003;97:1518-23.
12. Sauter AR, Dodgson MS, Stubhaug A, Halstensen AM, Klaastad 0. Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer-blinded, comparative study. Anesth Analg. 2008;106:1910-5.
13. Ponde VC, Diwan S. Does ultrasound guidance improve the success rate of infraclavicular brachial plexus block when compared with nerve stimulation in children with radial club hands? Anesth Analg. 2009;108:1967-70.
14. Chan VW, Perlas A, McCartney CJ, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007;54:176-82.
15. Casati A, Danelli G, Baciarello M, Corradi M, Leone S, Di Cianni S, et al. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology. 2007;106:992-6.
16. Yu W, Xu X, Wu DS, Guo XY, Huang PT. Efficacy of axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture technique. Zhonghua Yi Xue Za Zhi (Natl Med J China). 2007;87:740-5.
17. Oberndorfer U, Marhofer P, Bosenberg A, Willschke H, Felfernig M, Weintraud M, et al. Ultrasonographic guidance for sciatic and femoral nerve blocks in children. Br J Anaesth. 2007;98:797-801.
18. Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med. 2008;33:259-65.
19. Danelli G, Fanelli A, Ghisi D, Moschini E, Rossi M, Ortu A, et al. Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve block. Anaesthesia. 2009;64:638-42.
20. Van Geffen GJ, van den Broek E, Braak GJ, Giele JL, Gielen MJ, Scheffer GJ. A prospective randomised controlled trial of ultrasound guided versus nerve stimulation guided distal sciatic nerve block at the popliteal fossa. Anaesth Intensive Care. 2009;37:32-7.
21. Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408-17.
22. Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med. 2013;38:289-97.
23. Hadzic A, Sala-Blanch X, Xu D. Ultrasound guidance may reduce but not eliminate complications of peripheral nerve blocks. Anesthesiology. 2008;108:557-8.
24. Paloma Morillas-Sendin MD, Alejandro Ortega-Romero MD, Concepción del-Olmo MD. Basic considerations before injections and scanning techniques. Tech Reg Anesth Pain Manag. 2013;17:53-63.
25. Chapman GA, Johnson D, Bodenham AR. Visualization of needle position using ultrasonography. Anesthesia. 2006;61:148-58.
26. Sites BD, Spence BC, Gallagher JD, Wiley CW, Bertrand ML, Blike GT. Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med. 2007;32:107-15.
27. Ajmal M, Power S, Smith T, Shorten GD. Ergonomic task analysis of ultrasound-guided femoral nerve block: a pilot study. J Clin Anesth. 2011;23:35-41.
28. Langford RA, Hockey B, Leslie K. Monitor position and the accuracy and speed of ultrasound-guided nerve blocks. Anaesthesia. 2009;64:845-9.
29. Speer M, McLennan N, Nixon C. Novice learner in-plane ultrasound imaging: which visualization technique? Reg Anesth Pain Med. 2013;38:350-2.
30. Wilson JM, Germain G, Vaghadia H, Tang R, Sawka A. In-plane ultrasound-guided needle insertion ALONG or ACROSS the visual axis hand positions. Br J Anaesth. 2014;113:717-8.
31. Stone R, McCloy R. Ergonomics in medicine and surgery. BMJ. 2004;328:1115-8.
32. Berguer R. The application of ergonomics in the work environment of general surgeons. Rev Environ Health. 1997;12:99-106.
33. Friesdorf W, Konichezky S, Gross-Alltag F, Schwilk B. Ergonomics applied to anaesthesia record keeping. J Clin Monit Comput. 1993;10:251-9.
34. Smith AF, Pope C, Goodwin D, Mort M. What defines expertise in regional anaesthesia? An observational analysis of practice. Br J Anaesth. 2006;97:401-7.
35. Fletcher GC, McGeorge P, Flin RH, Glavin RJ, Maran NJ. The role of non-technical skills in anaesthesia: a review of current literature. Br J Anaesth. 2002;88:418-29.
36. Sites BD, Chan VW, Neal JM, Weller R, Grau T, Koscielniak-Nielsen ZJ, et al. American Society of Regional Anesthesia and Pain Medicine, European Society of Regional Anaesthesia and Pain Therapy Joint Committee: the American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee recommendations for education and training in ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2010;35:S74-80.
37. Marhofer P, Chan VWS. Ultrasound-guided regional anaesthesia: current concepts and future trends. Anaesth Analg. 2007;104:1265-9.
38. de Oliveira Filho GR, Helayel PE, da Conceicao DB, Garzel IS, Pavei P, Ceccon MS. Learning curves and mathematical models for interventional ultrasound basic skills. Anesth Analg. 2008;106:568-73.
39. Sites BD, Gallagher JD, Cravero J, Lundberg J, Blike G. The learning curve associated with a simulated ultrasound-guided interventional task by inexperienced anesthesia residents. Reg Anesth Pain Med. 2004;29: 544-8.
40. Chin KJ, Tse C, Chan V, Tan JS, Lupu CM, Hayter M. Hand motion analysis using the imperial college surgical assessment device: validation of a novel and objective performance measure in ultrasound-guided peripheral nerve blockade. Reg Anesth Pain Med. 2011;36:213-9.
41. Esser AC, Koshy JG, Randle HW. Ergonomics in office-based surgery: a survey-guided observational study. Dermatol Surg. 2007;33:1304-14.
42. Baker JP, Coffin CT. The importance of an ergonomic workstation to practicing sonographers. J Ultrasound Med. 2013;32:1363-75.
43. Koscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand. 2008;52:727-37.
44. Chin KJ, Perlas A, Chan VW, Brull R. Needle visualization in ultrasound-guided regional anesthesia: challenges and solutions. Reg Anesth Pain Med. 2008;33:532-44.
45. Bloc S, Ecoffey C, Dhonneur G. Controlling needle tip progression during ultrasound guided regional anesthesia using the hydrolocalization technique. Reg Anesth Pain Med. 2008;33:382-3.
46. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7-17.
47. Occupational Safety and Health Administration. Clinical services: sonography. Occupational Safety and Health Administration; 2008 [Cited 2014 Dec 15]. Available from: http://www.osha.gov/SLTC/etools/hospital/sonography/sonography.html.
48. Brodsky JB, Mariano ER. Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance. Best Pract Res Clin Anaesthesiol. 2011;25:61-72.
49. Evans K, Roll S, Baker J. Work-related musculoskeletal disorders (WRMSD) among registered diagnostic medical sonographers and vascular technologists: a representative sample. J Diagn Med Sonography. 2009;25:287-99.
50. Evans K, Roll SC, Hutmire C, Baker JP. Factors that contribute to wrist-hand-finger discomfort in diagnostic medical sonographers and vascular technologists. J Diagn Med Sonography. 2010;26:121-9.
51. Society of Diagnostic Medical Sonography. Industry standards for the prevention of work-related musculoskeletal disorders in sonography. Society of Diagnostic Medical Sonography; 2003 [Cited 2014 Dec 15]. Available from: http://www.sdms.org/pdf/wrmsd2003.pdf.
2. Choquet O, Abbal B, Capdevila X. The new technological trends in ultrasound-guided regional anesthesia. Curr Opin Anaesthesiol. 2013;26:605-12.
3. Onishi E, Yamauchi M. The trends of ultrasound-guided neuraxial block. Masui. 2014;63:1011-7.
4. Marhofer P, Harrop-Griffiths W, Kettner SC, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 1. Br J Anaesth. 2010;104:538-46.
5. Horlocker TT, Wedel DJ. Ultrasound-guided regional anaesthesia: the search for the holy grail. Anesth Analg. 2007;104:1009-11.
6. McCartney CJ, Dickinson V, Dubrowski A, Riazi S, McHardy P, Awad IT. Ultrasound provides a reliable test of local anesthetic spread. Reg Anesth Pain Med. 2010;35:361-3.
7. Salinas FV, Hanson NA. Evidence-based medicine for ultrasound-guided regional anesthesia. Anesthesiol Clin. 2014;32:771-87.
8. Gelfand HJ, Ouanes JP, Lesley MR, Ko PS, Murphy JD, Sumida SM, Isaac GR, Kumar K, Wu CL. Analgesic efficacy of ultrasound-guided regional anesthesia: a meta-analysis. J Clin Anesth. 2011;23:90-6. [ Links ]
9. Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, et al. Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med. 2008;33:253-8. [ Links ]
10. Liu SS, Zayas VM, Gordon MA, Beathe JC, Maalouf DB, Paroli L, et al. A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms. Anesth Analg. 2009;109:265-71. [ Links ]
11. Williams SR, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, et al. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg. 2003;97:1518-23.
12. Sauter AR, Dodgson MS, Stubhaug A, Halstensen AM, Klaastad 0. Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer-blinded, comparative study. Anesth Analg. 2008;106:1910-5.
13. Ponde VC, Diwan S. Does ultrasound guidance improve the success rate of infraclavicular brachial plexus block when compared with nerve stimulation in children with radial club hands? Anesth Analg. 2009;108:1967-70.
14. Chan VW, Perlas A, McCartney CJ, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth. 2007;54:176-82.
15. Casati A, Danelli G, Baciarello M, Corradi M, Leone S, Di Cianni S, et al. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology. 2007;106:992-6.
16. Yu W, Xu X, Wu DS, Guo XY, Huang PT. Efficacy of axillary approach brachial plexus blocking by ultrasound-guided four points via one-puncture technique. Zhonghua Yi Xue Za Zhi (Natl Med J China). 2007;87:740-5.
17. Oberndorfer U, Marhofer P, Bosenberg A, Willschke H, Felfernig M, Weintraud M, et al. Ultrasonographic guidance for sciatic and femoral nerve blocks in children. Br J Anaesth. 2007;98:797-801.
18. Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S. Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med. 2008;33:259-65.
19. Danelli G, Fanelli A, Ghisi D, Moschini E, Rossi M, Ortu A, et al. Ultrasound vs nerve stimulation multiple injection technique for posterior popliteal sciatic nerve block. Anaesthesia. 2009;64:638-42.
20. Van Geffen GJ, van den Broek E, Braak GJ, Giele JL, Gielen MJ, Scheffer GJ. A prospective randomised controlled trial of ultrasound guided versus nerve stimulation guided distal sciatic nerve block at the popliteal fossa. Anaesth Intensive Care. 2009;37:32-7.
21. Abrahams MS, Aziz MF, Fu RF, Horn JL. Ultrasound guidance compared with electrical neurostimulation for peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Br J Anaesth. 2009;102:408-17.
22. Barrington MJ, Kluger R. Ultrasound guidance reduces the risk of local anesthetic systemic toxicity following peripheral nerve blockade. Reg Anesth Pain Med. 2013;38:289-97.
23. Hadzic A, Sala-Blanch X, Xu D. Ultrasound guidance may reduce but not eliminate complications of peripheral nerve blocks. Anesthesiology. 2008;108:557-8.
24. Paloma Morillas-Sendin MD, Alejandro Ortega-Romero MD, Concepción del-Olmo MD. Basic considerations before injections and scanning techniques. Tech Reg Anesth Pain Manag. 2013;17:53-63.
25. Chapman GA, Johnson D, Bodenham AR. Visualization of needle position using ultrasonography. Anesthesia. 2006;61:148-58.
26. Sites BD, Spence BC, Gallagher JD, Wiley CW, Bertrand ML, Blike GT. Characterizing novice behavior associated with learning ultrasound-guided peripheral regional anesthesia. Reg Anesth Pain Med. 2007;32:107-15.
27. Ajmal M, Power S, Smith T, Shorten GD. Ergonomic task analysis of ultrasound-guided femoral nerve block: a pilot study. J Clin Anesth. 2011;23:35-41.
28. Langford RA, Hockey B, Leslie K. Monitor position and the accuracy and speed of ultrasound-guided nerve blocks. Anaesthesia. 2009;64:845-9.
29. Speer M, McLennan N, Nixon C. Novice learner in-plane ultrasound imaging: which visualization technique? Reg Anesth Pain Med. 2013;38:350-2.
30. Wilson JM, Germain G, Vaghadia H, Tang R, Sawka A. In-plane ultrasound-guided needle insertion ALONG or ACROSS the visual axis hand positions. Br J Anaesth. 2014;113:717-8.
31. Stone R, McCloy R. Ergonomics in medicine and surgery. BMJ. 2004;328:1115-8.
32. Berguer R. The application of ergonomics in the work environment of general surgeons. Rev Environ Health. 1997;12:99-106.
33. Friesdorf W, Konichezky S, Gross-Alltag F, Schwilk B. Ergonomics applied to anaesthesia record keeping. J Clin Monit Comput. 1993;10:251-9.
34. Smith AF, Pope C, Goodwin D, Mort M. What defines expertise in regional anaesthesia? An observational analysis of practice. Br J Anaesth. 2006;97:401-7.
35. Fletcher GC, McGeorge P, Flin RH, Glavin RJ, Maran NJ. The role of non-technical skills in anaesthesia: a review of current literature. Br J Anaesth. 2002;88:418-29.
36. Sites BD, Chan VW, Neal JM, Weller R, Grau T, Koscielniak-Nielsen ZJ, et al. American Society of Regional Anesthesia and Pain Medicine, European Society of Regional Anaesthesia and Pain Therapy Joint Committee: the American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anaesthesia and Pain Therapy Joint Committee recommendations for education and training in ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2010;35:S74-80.
37. Marhofer P, Chan VWS. Ultrasound-guided regional anaesthesia: current concepts and future trends. Anaesth Analg. 2007;104:1265-9.
38. de Oliveira Filho GR, Helayel PE, da Conceicao DB, Garzel IS, Pavei P, Ceccon MS. Learning curves and mathematical models for interventional ultrasound basic skills. Anesth Analg. 2008;106:568-73.
39. Sites BD, Gallagher JD, Cravero J, Lundberg J, Blike G. The learning curve associated with a simulated ultrasound-guided interventional task by inexperienced anesthesia residents. Reg Anesth Pain Med. 2004;29: 544-8.
40. Chin KJ, Tse C, Chan V, Tan JS, Lupu CM, Hayter M. Hand motion analysis using the imperial college surgical assessment device: validation of a novel and objective performance measure in ultrasound-guided peripheral nerve blockade. Reg Anesth Pain Med. 2011;36:213-9.
41. Esser AC, Koshy JG, Randle HW. Ergonomics in office-based surgery: a survey-guided observational study. Dermatol Surg. 2007;33:1304-14.
42. Baker JP, Coffin CT. The importance of an ergonomic workstation to practicing sonographers. J Ultrasound Med. 2013;32:1363-75.
43. Koscielniak-Nielsen ZJ. Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand. 2008;52:727-37.
44. Chin KJ, Perlas A, Chan VW, Brull R. Needle visualization in ultrasound-guided regional anesthesia: challenges and solutions. Reg Anesth Pain Med. 2008;33:532-44.
45. Bloc S, Ecoffey C, Dhonneur G. Controlling needle tip progression during ultrasound guided regional anesthesia using the hydrolocalization technique. Reg Anesth Pain Med. 2008;33:382-3.
46. Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7-17.
47. Occupational Safety and Health Administration. Clinical services: sonography. Occupational Safety and Health Administration; 2008 [Cited 2014 Dec 15]. Available from: http://www.osha.gov/SLTC/etools/hospital/sonography/sonography.html.
48. Brodsky JB, Mariano ER. Regional anaesthesia in the obese patient: lost landmarks and evolving ultrasound guidance. Best Pract Res Clin Anaesthesiol. 2011;25:61-72.
49. Evans K, Roll S, Baker J. Work-related musculoskeletal disorders (WRMSD) among registered diagnostic medical sonographers and vascular technologists: a representative sample. J Diagn Med Sonography. 2009;25:287-99.
50. Evans K, Roll SC, Hutmire C, Baker JP. Factors that contribute to wrist-hand-finger discomfort in diagnostic medical sonographers and vascular technologists. J Diagn Med Sonography. 2010;26:121-9.
51. Society of Diagnostic Medical Sonography. Industry standards for the prevention of work-related musculoskeletal disorders in sonography. Society of Diagnostic Medical Sonography; 2003 [Cited 2014 Dec 15]. Available from: http://www.sdms.org/pdf/wrmsd2003.pdf.
How to Cite
1.
Aguirre-Ospina OD, González-Maldonado JF, Ríos-Medina Ángela M. Ergonomics in ultrasound-guided nerve blocks. Colomb. J. Anesthesiol. [Internet]. 2015 Oct. 1 [cited 2024 Apr. 23];43(4):331–339. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/356
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Published
2015-10-01
How to Cite
1.
Aguirre-Ospina OD, González-Maldonado JF, Ríos-Medina Ángela M. Ergonomics in ultrasound-guided nerve blocks. Colomb. J. Anesthesiol. [Internet]. 2015 Oct. 1 [cited 2024 Apr. 23];43(4):331–339. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/356
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Narrative review
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