Visibility Of Three Kinds Of Needles Under Ultrasound And Comparison Of Their Application In Ultrasound-guided Transversus Abdominis Plane Block

Purpose: Ultrasound-guided technology is widely used for perioperative nerve block because of its convenience,safety,and real-time imaging.However,in clinical practice,there are still problems such as poor visualization of the needle and inability to locate the needle tip,which leads to a decrease in the success rate and an increase in complications of the operation.Improving the visualization of needles and increasing the success rate of puncture is one of the clinical problems in this field that needs to be urgently solved.Previous studies have shown that the visualization of the needle is related to the characteristics of the tissue,the echogenicity of the needle,and the angle between the ultrasound beam and the surface of the needle.The ultrasound beam through mirror reflection back to the ultrasound probe to form an ultrasound image.Therefore,the smaller the puncture angle with the skin,the higher the visualization of the needle.However,it is impossible to maintain a small puncture angle in different clinical situations.For this reason,people continue to explore ways to improve the visualization level of the needle.Among them,people added irregular notches or small incisions on the surface of the needle to increase the scattering of ultrasonic waves,hoping to achieve this goal.At present,there are several products available for clinical,and our early application found that the improvement of the visualization level of these products is far from the ideal level.This study first compared the visualization of needles with ordinary needles and two types of enhanced Echogenic needles at different puncture angles through a pork model.Secondly,the results obtained from the in vitro model were applied to the ultrasound-guided transversus abdominis plane block in clinical.By observing and comparing the effects and deficiencies of needles,it provides a basis for the development of next-generation products.Methods:In the pork model,using needle guides insert the common needle(C),Pajunk needle(P),and camel needle(T)at 15 °,30 °,45 °,and 60 ° angles,respectively.All of the above uses in-plane technology,and divided into 12 groups according to the angle(C15,C30,C45,C60,P15,P30,P45,P60,T15,T30,T45,T60 groups),20 cases in each group.Compared the visualization of needles with ordinary needles and two types of enhanced Echogenic needles at different puncture angles through a pork model.A total of 120 patients undergoing abdominal surgery were selected.Patients with coagulopathy,infection or damage at the puncture site,history of abdominal surgery,and history of local anesthetic allergies were excluded.Patients are grouped according to the above test results by the random number,20 people per group.The main observation index was the puncture needle clarity score,and the secondary observation index was the pain score and puncture complications(including bleeding at the puncture site,local anesthetic toxicity,and intraperitoneal injection).Results:(1)The results of the model test of isolated pork showed that at different angles,the C15 and C30 groups,C45 and C60 groups,P15 and P30 groups,and P45 and P60 groups had no statistically significant differences in the visualization of the needles.(P> 0.05);The C15 and C30 groups were better than the C45 and C60 groups,and the P15 and P30 groups were better than the P45 and P60 groups.The differences between the groups were statistically significant(p <0.05);However,there was no statistical difference between the T15,T30,T45 and T60 groups(p>0.05).In terms of different needle at the same angle,there was no significant difference in the visualization of the needles between the P15 and T15 groups,the P30 and T30 groups,the P45 and T45 groups,and the P60 and T60 groups(P> 0.05);The visualization of the needles in the P15 and T15 groups is higher than C15 group,the P30 and T30 groups is higher than C30 group,and the P60 and T60 groups is higher than the C60 group,the differences were statistically significant(p <0.05).(2)In the transversus abdominis plane block,There were no statistically significant differences in general information including age,height,weight,and BMI among the P30,T30,T45,and T60 groups(p> 0.05).There was no significant difference in the visualization of the needles between the four groups(P> 0.05).The pain score during puncture was higher in the P30 group than in the T30,T45,and T60 groups,and the differences were statistically significant(P <0.05).The incidence of puncture site bleeding was 25% in the P30 group,10%in the T30 group,5% in the T45 group,and 5.6% in the T60 group,with no significant difference(P> 0.05).There was no local anesthetic poisoning or intraperitoneal injection in the four groups.Conclusion:(1)In the transversus abdominis plane block,compared with Pajunk needle,theadjustable angle range of the TUORen needles for clear visualization is wider and the clinical effect is better.(2)Compared with TUORen needles,Pajunk needles have greater irritation during puncture,which increases the patient's pain and discomfort.