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Evaluation of contrast-enhanced ultrasonography with Sonazoid® in visualization of local anesthetic distribution in rectus sheath block: a prospective, clinical study

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Abstract

Purpose

Clear visualization of ultrasound (US) images is crucial for successful US-guided nerve block. However, accurate determination of local anesthetic (LA) distribution from US images remains difficult. Sonazoid®, which comprises perflubutane microbubbles, is used to diagnose hepatic and breast tumors. This study aimed to investigate the visibility of Sonazoid® in perioperative US-guided nerve block.

Methods

We performed rectus sheath block (RSB) in patients scheduled for laparoscopic abdominal surgery (n = 10). 10 mL of a mixture containing equal amounts of 0.75% ropivacaine and iohexol with the addition of Sonazoid® diluted 100-fold was administered. We investigated the correlation and agreement between Sonazoid® and iohexol distributions. The brightness of the solution and tissues was calculated: a grayscale value between 0 (dark) and 255 (bright) was measured in all pixels of the region of interest. Adverse events were also investigated.

Results

Sonazoid® was clearly visualized and distinguished from the surrounding tissues both during and after RSB. The spread of Sonazoid® and iohexol was significantly correlated (spearman’s ρ = 0.53, p = 0.0004). Bland–Altman analyses revealed significant mean difference between two methods (15.6 mm; 95% confidence interval [CI]: 10.6, 20.6; standard deviation (SD) 15.65; p < 0.0001). Limits of agreement were − 14.94 to 46.24 mm. Sonazoid® significantly increased the mean grayscale values at the posterior rectus sheath (93.7 vs. 201.9, p < 0.0001). There were no complications.

Conclusion

Sonazoid diluted 100-fold® was clearly visualized real-time, and the enhancement was sustained and measurable after RSB. Sonazoid® could potentially be used for the contrast agent of US-guided nerve block.

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Acknowledgements

This work was supported by JSPS KAKENHI Grant Numbers #19K18235 and #21H03023.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Eiko Onishi, Kazutomo Saito, Michio Kumagai, Toru Murakami, Shigekazu Sugino & Masanori Yamauchi

  2. Department of Anesthesiology, South Miyagi Medical Center, Ogawara, Miyagi, Japan

    Ruri Oba

Authors
  1. Eiko Onishi
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  2. Kazutomo Saito
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  3. Michio Kumagai
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  4. Ruri Oba
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  5. Toru Murakami
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  6. Shigekazu Sugino
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  7. Masanori Yamauchi
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Contributions

E.O and MY designed the study and E.O. wrote the manuscript with support from all authors. TM checked the protocol of study. SS supervised the analytical methods. EO, RO, MK, and MY performed RSB and measured Sonazoid® distribution. KS measured iohexol distribution in abdominal radiographic images. All authors discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Eiko Onishi.

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Supplementary Information

Below is the link to the electronic supplementary material.

Online Resource 1. Contrast-enhanced ultrasound-guided rectus sheath block.The contrast-enhanced ultrasound had a double display. The Left display was Sonazoid® enhanced mode, and the Right display was B-mode. The needle and local anesthetic were clearly visualized in contrast-enhanced ultrasonography

Online Resource 2. Contrast-enhanced ultrasound-guided rectus sheath block. The contrast-enhanced ultrasound had a double display. The Left display was Sonazoid® enhanced mode, and the Right display was B-mode. The needle and local anesthetic were clearly visualized in contrast-enhanced ultrasonography

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Onishi, E., Saito, K., Kumagai, M. et al. Evaluation of contrast-enhanced ultrasonography with Sonazoid® in visualization of local anesthetic distribution in rectus sheath block: a prospective, clinical study. J Anesth 36, 405–412 (2022). https://doi.org/10.1007/s00540-022-03063-6

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  • DOI: https://doi.org/10.1007/s00540-022-03063-6

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