Lori A Stolz1, Josie Galarza Acuna2, Kevin Gaskin3, Amanda M Murphy4, Lucas Friedman5, Summer Stears-Ellis6, Parisa Javedani7, Uwe Stolz8, Srikar Adhikari9. 1. Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona. lori.a.stolz@gmail.com. 2. Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona. jacuna86@gmail.com. 3. Upstate Medical University, State University of New York, Syracuse, NY. taichibee@gmail.com. 4. Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona. amurphy@aemrc.arizona.edu. 5. Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona. LFriedman@aemrc.arizona.edu. 6. Kaiser Permanente, Portland, OR. drink__milk@hotmail.com. 7. Tucson Medical Center, Tucson, AZ. pjavedani@gmail.com. 8. Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona. uestolz@gmail.com. 9. Department of Emergency Medicine, Banner University Hospital, Tucson, Arizona. sadhikari@aemrc.arizona.edu.
Abstract
AIM: Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves. MATERIAL AND METHODS: This is a prospective observational study. A convenience sample of adult emergency department patients were enrolled. Gender, BMI, history of diabetes, neck circumference and arm circumference were recorded. Sonographic images of the brachial plexus at interscalene and supraclavicular levels, the median, the radial and ulnar nerves were recorded. Three reviewers independently graded the echogenicity and visibility using subjective scales. RESULTS: 395 peripheral nerves were included. Nerves of the forearm (median, ulnar, radial nerves) were found to be more echogenic (OR=9.3; 95% CI: 5.7, 15.3) and visible (OR=10.0; 6.3, 16.0) than more proximal nerves (brachial plexus at interscalene and supraclavicular levels). Gender, BMI, and history of diabetes mellitus were not significantly related to nerve visibility (p=0.9, 0.2, 0.2, respectively) or echogenicity (p=0.3, 0.8, 0.3). Neck circumference was not related to visibility or echogenicity of proximal nerves. Increased forearm circumference improved echogenicity (OR=1.25; 1.09, 1.43) but not visibility of forearm nerves. CONCLUSIONS: Gender, BMI and presence of diabetes were not related to echogenicity or visibility of upper extremity nerves. Increasing forearm circumference was associated with increased echogenicity of the adjacent nerves, but not visibility. Neck circumference was not associated with either nerve visibility or echogenicity of brachial plexus nerve bundles.
AIM: Regional anesthesia with ultrasound-guidance is an excellent option for pain control if nerves are adequately visualized. Gender, body mass index (BMI), history of diabetes, neck and forearm circumference may affect echotexture and visualization. This study evaluates patient characteristics for their ability to predict the echogenicity or visibility of upper extremity peripheral nerves. MATERIAL AND METHODS: This is a prospective observational study. A convenience sample of adult emergency department patients were enrolled. Gender, BMI, history of diabetes, neck circumference and arm circumference were recorded. Sonographic images of the brachial plexus at interscalene and supraclavicular levels, the median, the radial and ulnar nerves were recorded. Three reviewers independently graded the echogenicity and visibility using subjective scales. RESULTS: 395 peripheral nerves were included. Nerves of the forearm (median, ulnar, radial nerves) were found to be more echogenic (OR=9.3; 95% CI: 5.7, 15.3) and visible (OR=10.0; 6.3, 16.0) than more proximal nerves (brachial plexus at interscalene and supraclavicular levels). Gender, BMI, and history of diabetes mellitus were not significantly related to nerve visibility (p=0.9, 0.2, 0.2, respectively) or echogenicity (p=0.3, 0.8, 0.3). Neck circumference was not related to visibility or echogenicity of proximal nerves. Increased forearm circumference improved echogenicity (OR=1.25; 1.09, 1.43) but not visibility of forearm nerves. CONCLUSIONS: Gender, BMI and presence of diabetes were not related to echogenicity or visibility of upper extremity nerves. Increasing forearm circumference was associated with increased echogenicity of the adjacent nerves, but not visibility. Neck circumference was not associated with either nerve visibility or echogenicity of brachial plexus nerve bundles.
Authors: Ryan V Tucker; William J Peterson; Jennifer T Mink; Lindsay A Taylor; Stephen J Leech; Arun D Nagdev; Megan Leo; Rachel Liu; Lori A Stolz; Ross Kessler; Creagh T Boulger; Elaine H Situ-LaCasse; Jacob O Avila; Robert Huang Journal: AEM Educ Train Date: 2020-12-11
Authors: Jason K Panchamia; Ram Jagannathan; Bridget P Pulos; Adam W Amundson; Joaquin Sanchez-Sotelo; David P Martin; Hugh M Smith Journal: BMC Anesthesiol Date: 2021-07-09 Impact factor: 2.217