Clinical Assessment Of Pajunk-enhanced Echogenic Needle In Brachial Plexus Block

Objective:Ultrasound-guided peripheral plexus block is widely used in clinic because it can show the route of puncture needle,the position of needle tip and the diffusion of local anesthetics.However,in clinical practice,there are often cases where the puncture needle is poorly displayed,the needle tip is offset,and the operation time is too long and the number of punctures is excessive.How to improve needle visibility,reducing the number of punctures and increasing the success rate of the blockage,is one of the important problems that need to be solved.According to the diffuse reflection principle,the Pajunk puncture needle with surface of groove has more visibility under ultrasound.In this study,the Pajunk puncture needle was applied to the ultrasound-guided brachial plexus block.The effect of puncture needle ultrasound imaging was observed and assessment of Pajunk enhanced echogenic needle was explored in order to provide guidance for clinical ultrasound-guided plexus block,making plexus block more safe and effective.Methods:A total of 60 adult patients,ASA I-II,aged 18-70 years old,scheduled for upper limb operation,were enrolled.Patients with major systemic diseases,the history of local anaesthetic allergy,nervous system diseases and puncture site accompanied by skin damage and infection were excluded.The patients included were randomly divided into two groups,Pajunk enhanced echogenic needle group?22G,50mm,group E,n=30?and normal needle group?22G,50mm,group N,n=30?.All patients were accepted ultrasound-guided brachial plexus block.The primary outcomes included needle visibility score,puncture times,operation time and satisfaction;secondary outcomes included the onset time of sensory and motor block,duration of sensory block and duration of motor block,complications and hemodynamic changes.Results:Sixty patients underwent upper limb surgery following brachial plexus block were selected.One patient in group N was excluded.Thirty patients were in group E and 29 in group N.The results showed that there were no significant difference in gender,height,weight,BMI,age,and operation time between the both groups?P>0.05?;Twenty-eight?93.33%?patients had a better needle visibility in group E,12?41.38%?patients in group N;The score of needle visibility was 2.4±0.7 in group E and 1.4±0.7in group N;Compared with group N,the imaging of the needle in the group E was significantly improved?P<0.05?;Twenty-eight patients?93.33%?were satisfied with the nerve block effect in the group E,and 21 patients?72.41%?were in the group N.Patients satisfaction of in group E was significantly higher than that in group N?P<0.05?;In clinical application,compared with group N,the number of puncture in group E was less?1.3±0.4 vs 1.6±0.6,P<0.05?,Blocking time?5.0±1.4 vs 8.1±1.4,P<0.05?,sensory block onset time?8.3±1.0 vs 11.0±1.5,P<0.05?and onset time of motor block were shorter?11.4±0.9 vs 14.7±1.4,P<0.05?;sensory block duration?547.7±31.6 vs 460.7±38.9,P<0.05?and motor block duration?452.1±45.1 vs357.9±30.5,P<0.05?were longer.For complications,the incidence of pain during puncture in group E?73.3%vs 34.5%?,incidence of bleeding at the puncture site?26.7%vs 10.3%?and needle insertion The distress ratio?83.3%vs 6.9%?was significantly higher compared with group N.At T₁ and T₂,there were no significant difference in SBP,DBP and HR between the two groups?P>0.05?.At T₃ and T₄,SBP,DBP and HR were lower than group N.The difference was statistically significant?P<0.05?.Conclusion:Pajunk enhanced echogenic needle could improve needle visibility and be better used for block brachial plexus under the guidance of ultrasound.However,there are still deficiencies in the design of needle and need for further improvement.