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Possible utility of contrast-enhanced ultrasonography for detecting spread of local anesthetic in nerve block

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Abstract

Purpose

This study demonstrated the effects of perfluorobutane (Sonazoid®) with contrast-enhanced ultrasonography (CEUS) to identify the spread of local anesthetics in ultrasound-guided nerve block.

Methods

This study consists of simulation, cadaveric, and animal studies. In a simulation study, 1% lidocaine with 10- to 1000-fold diluted Sonazoid®, a US-specific contrast agent to diagnose hepatic and breast cancers (0.5 mL), was injected into a resin-based phantom to determine the optimal concentration for ultrasound-guided peripheral nerve block. The enhanced area was measured by direct observation and ultrasonography (US). In the cadaver study, ultrasound-guided sciatic nerve block was performed at the popliteal fossa in the 9 extremities, and 5 mL of the optimally diluted Sonazoid® defined in the simulation study with X-ray contrast medium and blue dye was injected. Longitudinal spread of the solution was measured by CEUS, X-ray imaging and anatomical dissection. In the animal study, the optimally diluted Sonazoid® was injected around the sciatic nerve of rats (n = 6), and neuronal function and toxicity were evaluated by behavioral and histological estimation.

Results

The simulation study proved that 100-fold diluted Sonazoid® was the optimal concentration. In the cadaver study, CEUS and anatomical dissection (r = 0.90, P = 0.0020) or radiography (r = 0.84, P = 0.0072) showed high agreement and correlation with the longitudinal spread. CEUS clearly showed a fine intraneuronal injection image compared to the usual B-mode imaging. The animal study suggested no adverse effects by co-administration of lidocaine and Sonazoid®.

Conclusions

CEUS with 100-fold diluted Sonazoid® could identify the spread of local anesthetic as well as radiography and anatomical dissection, and distinguish between intra- and extraneuronal injections without neurodegeneration.

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References

  1. Schnabel A, Meyer-Frießem CH, Zahn PK, Pogatzki-Zahn EM. Ultrasound compared with nerve stimulation guidance for peripheral nerve catheter placement: a meta-analysis of randomized controlled trials. Br J Anaesth. 2013;111:564–72.

    Article  CAS  PubMed  Google Scholar 

  2. Kent ML, Hackworth RJ, Riffenburgh RH, Kaesberg JL, Asseff DC, Lujan E, Corey JM. A comparison of ultrasound-guided and landmark-based approaches to saphenous nerve blockade: a prospective, controlled, blinded, crossover trial. Anesth Analg. 2013;117:265–70.

    Article  PubMed  Google Scholar 

  3. Sala-Blanch X, de Riva N, Carrera A, López AM, Prats A, Hadzic A. Ultrasound-guided popliteal sciatic block with a single injection at the sciatic division results in faster block onset than the classical nerve stimulator technique. Anesth Analg. 2012;114:1121–7.

    Article  PubMed  Google Scholar 

  4. Lam NC, Petersen TR, Gerstein NS, Yen T, Starr B, Mariano ER. A randomized clinical trial comparing the effectiveness of ultrasound guidance versus nerve stimulation for lateral popliteal-sciatic nerve blocks in obese patients. J Ultrasound Med. 2014;33:1057–63.

    Article  PubMed  Google Scholar 

  5. Choquet O, Capdevila X. Three-dimensional high-resolution ultrasound-guided nerve blocks: a new panoramic vision of local anesthetic spread and perineural catheter tip location. Anesth Analg. 2013;116:1176–81.

    Article  PubMed  Google Scholar 

  6. Boezaart AP, Tighe P. New trends in regional anesthesia for shoulder surgery: avoiding devastating complications. Int J Shoulder Surg. 2010;4:1–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Jeng CL, Torrillo TM, Rosenblatt MA. Complications of peripheral nerve blocks. Br J Anaesth. 2010;105:97–107.

    Article  Google Scholar 

  8. Kudo M. Multistep human hepatocarcinogenesis: correlation of imaging with pathology. J Gastroenterol. 2009;44:112–8.

    Article  PubMed  Google Scholar 

  9. Hatanaka K, Chung H, Kudo M, Haji S, Minami Y, Maekawa K, Hayaishi S, Nagai T, Takita M, Kudo K, Ueda T, Tatsumi C, Kitai S, Ishikawa E, Yada N, Inoue T, Hagiwara S, Ueshima K. Usefulness of the post-vascular phase of contrast-enhanced ultrasonography with Sonazoid in the evaluation of gross types of hepatocellular carcinoma. Oncology. 2010;78:53–9.

    Article  PubMed  Google Scholar 

  10. Miyamoto Y, Ito T, Takada E, Omoto K, Hirai T, Moriyasu F. Efficacy of Sonazoid (perflubutane) for contrast-enhanced ultrasound in the differentiation of focal breast lesions: phase 3 multicenter clinical trial. Am J Roentgenol. 2014;202:400–7.

    Article  Google Scholar 

  11. Sontum PC. Physicochemical characteristics of Sonazoid, a new contrast agent for ultrasound imaging. Ultrasound Med Biol. 2008;34:824–33.

    Article  PubMed  Google Scholar 

  12. Wilson SR, Greenbaum LD, Goldberg BB. Contrast-enhanced ultrasound: what is the evidence and what are the obstacles? Am J Roentgenol. 2009;193:55–60.

    Article  Google Scholar 

  13. Benkhadra M, Faust A, Ladoire S, Trost O, Trouilloud P, Girard C, Anderhuber F, Feigl G. Comparison of fresh and Thiel’s embalmed cadavers according to the suitability for ultrasound-guided regional anesthesia of the cervical region. Surg Radiol Anat. 2009;31:531–5.

    Article  PubMed  Google Scholar 

  14. Benkhadra M, Lenfant F, Nemetz W, Anderhuber F, Feigl G, Fasel J. A comparison of two emergency cricothyroidotomy kits in human cadavers. Anesth Analg. 2008;106:182–5.

    Article  PubMed  Google Scholar 

  15. Andersen HL, Andersen SL, Tranum-Jensen J. Injection inside the paraneural sheath of the sciatic nerve: direct comparison among ultrasound imaging, macroscopic anatomy, and histologic analysis. Reg Anesth Pain Med. 2012;37:410–4.

    Article  CAS  PubMed  Google Scholar 

  16. Kroin JS, Buvanendran A, Williams DK, Wagenaar B, Moric M, Tuman KJ, Kerns JM. Local anesthetic sciatic nerve block and nerve fiber damage in diabetic rats. Reg Anesth Pain Med. 2010;35:343–50.

    Article  PubMed  Google Scholar 

  17. Lirk P, Flatz M, Haller I, Hausott B, Blumenthal S, Stevens MF, Suzuki S, Klimaschewski L, Gerner P. In Zucker diabetic fatty rats, subclinical diabetic neuropathy increases in vivo lidocaine block duration but not in vitro neurotoxicity. Reg Anesth Pain Med. 2012;37:601–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Gianolio DA, Philbrook M, Avila LZ, MacGregor H, Duan SX, Bernasconi R, Slavsky M, Dethlefsen S, Jarrett PK, Miller RJ. Synthesis and evaluation of hydrolyzable hyaluronan-tethered bupivacaine delivery systems. Bioconjug Chem. 2005;16:1512–8.

    Article  CAS  PubMed  Google Scholar 

  19. Tomita K, Kubo T, Matsuda K, Fujiwara T, Yano K, Winograd JM, Tohyama M, Hosokawa K. The neurotrophin receptor p75NTR in Schwann cells is implicated in remyelination and motor recovery after peripheral nerve injury. Glia. 2007;55:1199–208.

    Article  PubMed  Google Scholar 

  20. Forsberg F, Piccoli CW, Liu JB, Rawool NM, Merton DA, Mitchell DG, Goldberg BB. Hepatic tumor detection: MR imaging and conventional US versus pulse-inversion harmonic US of NC100100 during its reticuloendothelial system-specific phase. Radiology. 2002;222:824–9.

    Article  PubMed  Google Scholar 

  21. Ardelean M, Şirli R, Sporea I, Bota S, Martie A, Popescu A, Dănila M, Timar B, Buzas R, Lighezan D. Contrast enhanced ultrasound in the pathology of the pancreas − a monocentric experience. Med Ultrason. 2014;16:325–31.

    PubMed  Google Scholar 

  22. Görg C, Bert T. Contrast enhanced sonography of focal splenic lesions with a second-generation contrast agent. Ultraschall Med. 2005;26:470–7.

    Article  PubMed  Google Scholar 

  23. Schneider A, Johnson L, Goodwin M, Schelleman A, Bellomo R. Bench-to-bedside review: contrast enhanced ultrasonography−a promising technique to assess renal perfusion in the ICU. Crit Care. 2011;15:157.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Ormesher DC, Lowe C, Sedgwick N, McCollum CN, Ghosh J. Use of three-dimensional contrast-enhanced duplex ultrasound imaging during endovascular aneurysm repair. J Vasc Surg. 2014;60:1468–72.

    Article  PubMed  Google Scholar 

  25. Prantl L, Pfister K, Kubale R, Schmitt S, Stockhammer V, Jung W, Zorger N, Herold T, Nerlich M, Stehr A, Jung EM. Value of high resolution ultrasound and contrast enhanced US pulse inversion imaging for the evaluation of the vascular integrity of free-flap grafts. Clin Hemorheol Microcirc. 2007;36:203–16.

    CAS  PubMed  Google Scholar 

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Acknowledgements

We wish to thank to Professor Mineko Fujimiya (Department of Anatomy, Sapporo Medical University School of Medicine) for the preparation of Thiel-embalmed cadavers, and Tomohisa Niiya, Takeshi Murouchi, Eri Gi and Syunsuke Hayashi (Department of Anaesthesiology, Sapporo Medical University School of Medicine) for their excellent assistance. This work was supported by the Japan Society for the Promotion of Science KAKENHI Grant-in-Aid (Numbers: 25861388, 24592350).

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Correspondence to Masanori Yamauchi.

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Sasaki, H., Yamauchi, M., Ninomiya, T. et al. Possible utility of contrast-enhanced ultrasonography for detecting spread of local anesthetic in nerve block. J Anesth 31, 365–373 (2017). https://doi.org/10.1007/s00540-017-2347-x

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  • DOI: https://doi.org/10.1007/s00540-017-2347-x

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