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 Table of Contents  
LETTER TO EDITOR
Year : 2020  |  Volume : 5  |  Issue : 2  |  Page : 234-235

Costly nerve block needles for ultrasound.guided peripheral blocks! Is there a viable choice?


Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala, India

Date of Submission03-Mar-2020
Date of Decision02-May-2020
Date of Acceptance09-May-2020
Date of Web Publication18-Dec-2020

Correspondence Address:
Dr. Varun Suresh
Department of Anaesthesiology, Government Medical College, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/bjhs.bjhs_17_20

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How to cite this article:
Suresh V. Costly nerve block needles for ultrasound.guided peripheral blocks! Is there a viable choice?. BLDE Univ J Health Sci 2020;5:234-5

How to cite this URL:
Suresh V. Costly nerve block needles for ultrasound.guided peripheral blocks! Is there a viable choice?. BLDE Univ J Health Sci [serial online] 2020 [cited 2021 Apr 14];5:234-5. Available from: https://www.bldeujournalhs.in/text.asp?2020/5/2/234/303959



Sir,

Unfortunately, disposable peripheral nerve stimulator needles, which are most commonly used in ultrasound-guided nerve blocks, are being reused for their cost and availability. This leaves behind, breaches in the stringent aseptic techniques to be followed while instituting a nerve block.

We describe an indigenous affordable alternative for costlier nerve stimulator needle, combining a ubiquitous 22G Quincke–Babcock[1] spinal needle and an extension line attached to it. Whether to choose between venous and arterial extension line, depends on availability (note: pressure-monitoring lines need less priming volume). Preparation includes a 22G Quincke–Babcock spinal needle, made artificially blunt by rubbing over a sterile cloth to which an extension line is attached and then primed [Figure 1]. Then after, block is performed as a routine with reasonable reflection to ultrasound beams by these needles for identification [Figure 2].
Figure 1: Spinal needle with extension line

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Figure 2: Spinal needle under Ultrasonography guidance towards target nerve bundle

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Peripheral nerve stimulator needles were used in ultrasound-guided nerve blocks to provide additional safety from nerve damage as this technique combines both visual and electrical proximity to target nerve. Sooner, with expertise in sonology among anesthesiologists, there is a notable trend toward reserving nerve stimulation component limited to demonstrative purposes. Studies demonstrated that the risk of fascicle injury was lower with a short bevel needle penetrating a nerve than a long beveled one.[1] There are contrary studies as well.[2] Although it may be more difficult to enter a nerve fascicle with a short bevel needle, once pierced, the short bevel caused a more severe lesion.[3] Direct evidence for an association between needle tip design and the incidence of nerve injury is still nonconclusive.[4] Ultrasound guidance improved the efficiency of block in comparison with the peripheral nerve stimulator-guided methods, but whether ultrasound decreases the nerve injury need to be further evaluated.[5] Notably, postoperative neurological symptoms were more common in patients who experienced procedure induced paresthesia.

Although search for a nontraumatic, sonoreflective needle is in progress, most of these are still beyond the reach of practitioners in remote locations. A significant dearth of nerve stimulator needle, due to the unavailability and cost, compels many hospitals to resort to unhealthy practice of reusing these disposable needles, adding on to the obvious risks. Our indigenous combination of using a ubiquitous Quincke–Babcock spinal needle with a reasonable sonoreflective property and an extension line, addresses this issue. The 23G Quincke–Babcock spinal needle is blunted enough by rubbing on the sterile cloth, to reserve intraneural entry and provide the “feel” to the operator.

The relatively high cost and lack of hospital stocks of nerve stimulator needle become the limiting factor in popularizing the continued practice of ultrasound-guided peripheral nerve blocks in developing countries. Our technique can be a cost-effective alternative, especially in the hands of experienced anesthesiologists, who will be mostly under the pressure to reduce the cost of regional techniques. However, we still suggest the traditional combination techniques for novices, until the long-term safety of our method is evaluated by multicentric randomized trials.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Selander D, Dhunér KG, Lundborg G. Peripheral nerve injury due to injection needles used for regional anesthesia. An experimental study of the acute effects of needle point trauma. Acta Anaesthesiol Scand 1977;21:182-8.  Back to cited text no. 1
    
2.
Rice AS, McMahon SB. Peripheral nerve injury caused by injection needles used in regional anaesthesia: Influence of bevel configuration, studied in a rat model. Br J Anaesth 1992;69:433-8.  Back to cited text no. 2
    
3.
Selander D. Peripheral nerve injury caused by injection needles. Br J Anaesth 1993;71:323-5.  Back to cited text no. 3
    
4.
Shariat AN, Patrick MH. Equipments for peripheral nerve blocks. In: Hadzic A, editor. Hadzic's Peripheral Nerve Blocks. 2nd ed. New York: McGraw Hill Medical; 2012. p. 47.  Back to cited text no. 4
    
5.
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.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

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