Clearer, Brighter: Ultrasound and the CCR Revolution

A change in methodology created the need for an ultrasound-guided needle

By Zach Rogers

Editor, Havel’s Inc.

Part One: The early days of ultrasound in anesthesia

ultrasound_machine_2

Ultrasound has dramatically improved over the years, becoming more portable, more affordable and better able to provide a quality image on screen.

In recent years, there has been a shift towards using ultrasound guidance in a number of different regional anesthesia procedures. Most notably, ultrasound has emerged as a leading force in needle-injection procedures like peripheral nerve blocks and muscular skeletal injections, and because of this there is a large industry demand for better needles that perform well under ultrasound. The market for this demand has exploded in the last five years, and it’s still on the rise today. This new wave in ultrasound technology offers better image quality, better portability and more affordable pricing. Because of this, ultrasound guidance is becoming the standard of care for most regional anesthesia procedures.

The emergence of ultrasound-guided needle injections is due mostly to the significant benefits it provides. Doctors are now better able to position the needle where it’s needed, while at the same time monitor the distribution of the anesthetic in real-time. It also allows doctors to observe the needle’s trajectory as it’s inserted into the body, which makes avoiding internal structures easier than before. Adjustments can be made on the spot, and overall success rates are dramatically increased.

Of course, with new methods comes new tools for those methods, and anesthesia is no different. Since ultrasound guidance is becoming such a dominant practice for needle injections, it would be helpful if the needles could be seen clearly under ultrasound. Conventional needles are difficult to distinguish, and it became obvious that in order to make ultrasound guidance easier for doctors new to the technique, the needles themselves needed to be echogenic.

Echogenicity is the ability to bounce or reflect ultrasound waves back in order to see something clearly on the screen. When ultrasound began making its way into needle injections, the development of echogenic needles came into play. Visualization of the needle is the most important factor in developing better echogenic needle technology, and it can be challenging, especially at steep angles. As echogenic needles became more advanced, improvements were made that allowed doctors to see their needles more vividly than ever before.


Read part two of “Ultrasound and the CCR Revolution” on Friday!


Since 1981, Havel’s has offered premium quality ultrasound needles and procedures needles for anesthesia, pain control, radiology and biopsy, as well as sutures and surgical scalpel blades for doctors, hospitals, dentists, dermatologists, veterinarians and other leading medical professionals. To see Havel’s selection of procedure needles, sutures and surgical scalpel blades, please click here: Havel’s Ultrasound Needles, Sutures and Surgical Scalpel Blades.

 

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Regional Anesthesia Risks: Going From Lower to Lowest

More steps can be taken to decrease risk even more

Neurologic injury from regional anesthesia is very low

The risk of neurologic injury from regional anesthesia techniques is already low, but some feel it could be even lower. (Photo: Bigstock)

Can the risk of neurologic injury due to regional anesthesia go from very low to extremely low? That was the question on the minds of many anesthesiologists at this year’s International Symposium of Ultrasound for Regional Anesthesia, Pain Medicine and Perioperative Applications in Toronto, Canada.

Already, the risk of neurologic injury is low, but some say there are even more steps anesthesiologists can take to reduce the risk even lower.

“What we do is very safe, but this allows us to spend a lot of time talking about the optimal way to make things even safer,” said Kyle Kirkham, MD, FRCPC, staff anesthesiologist at Toronto Western Hospital, University Health Network and assistant professor to the Department of Anesthesia at the University of Toronto, Ontario, Canada. “Can we step back and find an approach that doesn’t require the needle to be in contact with the nerve at all?”

Ongoing research

Research based on the topic of increasing proximity to the nerve without causing injury has been done in the past, but now experts are calling on more alternative approaches to be looked at, such as maintaining a distance from the nerve while still delivering a sufficient diffusion of anesthetic.

Studies concerning current flow and twitch have shed some light on avoiding nerve damage, but nothing concrete has been set forth yet.

“We have discovered that a lot of studies have shown you can be touching the nerve and have high current and not get a twitch,” said Paul McHardy, MD, FRCPC, an anesthesiologist at Sunnybrook Health Sciences Centre in Toronto. “At the same time, you can be outside the nerve, have low current and have a twitch. The architectural structure of the nerves behaves differently in terms of risk.”

Using pressure as a measurement was thought to be a reliable way to minimize the risk of neurologic injury. However, one animal study showed that high injection pressures may suggest intraneural needle placement and result in persistent neurologic deficits, which led the authors to recommend against excessive injection pressure.

One anesthesiologist, Xavier Sala-Blanch, MD, director of the Orthopedic Anesthesia Section at the University of Barcelona, Spain, looked at retrospective research which determined ultrasound guidance can decrease the risk for local anesthetic systemic toxicity after a peripheral nerve blockade.

“It is important that we try to reduce the percentage of injury,” said Dr. Sala-Blanch. “Ultrasound helps us to do this.”

To read more on the topic of reducing the risks of regional anesthesia techniques, click here: Techniques Can Push Regional Anesthesia Risks Still Lower.


For more than 30 years, Havel’s has offered premium quality anesthesia needles and ultrasound needles for anesthesiologists, pain management specialists, physicians, doctors, hospitals and other leading medical professionals. To see Havel’s selection of anesthesia and pain control needles, please click here: Havel’s Anesthesia Needles and Pain Control Needles.

 

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Adverse Events With Cosmetic Skin Procedures Rare

Overall incidence was 0.24 percent

Minor cosmetic dermatology procedures safe

A new report shows that the majority of minor cosmetic dermatology procedures are safe and produce little to no adverse events. (Photo: Bigstock)

Some of the most common cosmetic dermatology procedures, including laser, other forms of energy and injection therapy, have been found to have little, if any, adverse events related to them according to a recent analysis of a large prospective database.

The analysis found a total of 48 adverse events that occurred in over 20,000 cosmetic procedures. Out of all the adverse events that did occur, none were found to be serious or life-threatening, and no incidence of hospitalization, mortality, serious illness or permanent injury were reported. The most common events were transient bruising or redness, minor hyper- or hypopigmentation or temporary “bumps” at the injection site for injectable treatments.

Murad Alam, MD, of Northwestern University in Chicago, and colleagues reported their findings online in JAMA Dermatology.

“The principal finding was what we had expected; basically, that the adverse event rate after minor cosmetic procedures is very low,” Alam said. “But it was a surprise at just how low the rate was. Not only was the rate very low, but the types of events we found were very innocuous.”

First of its kind

This is good news for the growing number of cosmetic procedures dermatologists perform every year. Even with the large numbers, adverse events had not been well documented up to this point. This is largely due to a lack of data on the subject. In order to avoid this, Alam and his colleagues approached the study from a unique standpoint. The main focus was to select a specific subset of patients – those treated with noninvasive and minimally invasive procedures involving lasers energy devices and injectable neurotoxins and fillers – and look at how frequent adverse events occurred in those patients.

“We included certain kinds of cosmetic procedures that are quite common,” said Alam. “Among those procedures would be filler procedures – injectable, prepackaged fillers for facial augmentation – neurotoxins and a number of laser and energy devices.” Laser and energy devices can include procedures such as hair removal, tattoo treatment and removal and wrinkle and fine line treatments.

By the numbers

The new study involved 23 cosmetic dermatologists across eight different locations. Researchers looked at data from procedures of interest performed between March 28 and December 30, 2011. This data included initial observations by participating dermatologists, patient-reported events and follow-up contact with patients via telephone. If an adverse event was suspected but not observed by a dermatologist, patients were asked to return for a follow-up exam within 24 hours.

In total the data was made up from 20,399 procedures, and the total incidence of adverse events was 0.24 percent. Adverse events were most commonly associated with procedures involving the cheeks, eyelids and nasolabial, or “laugh lines.”

“This multicenter prospective study of a large cohort of consecutively performed cosmetic procedures demonstrates that adverse events are uncommon after minimally invasive and noninvasive laser, energy device, filler and neurotoxin procedures,” the authors wrote. “Most adverse events were types that would be expected to resolve with treatment over weeks or months.”

“Patients seeking such procedures can be reassured that, at least in the hands of trained, board-certified dermatologists, [these procedures] pose minimal risk.”

For more information on the large scale study, click here: Few Adverse Events With Cosmetic Skin Procedures.


Since 1981, Havel’s has offered premium quality sutures and surgical scalpel blades for dermatologists, doctors, hospitals and other leading medical professionals. To see Havel’s selection of sutures and surgical scalpel blades, please click here: Havel’s Sutures and Surgical Scalpel Blades.


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New PTSD Treatment Offers Relief With Neck Injections

Researchers say technique relieved symptoms in 70 percent of combat veterans

SGB treatment for combat troops and veterans suffering from PTSD

A new treatment option for PTSD called a stellate ganglion block, or SGB, could provide relief for combat troops and veterans suffering from the disorder.

A new report published in the October issue of Military Medicine found that an anesthesia technique called a stellate ganglion block, or SGB, could provide much needed relief for soldiers suffering from post-traumatic stress disorder. The report showed that over 70 percent of combat veterans who received the treatment once or more said it relieved symptoms of PTSD such as sleep disturbances, anxiety and depression, as measured by a checklist in nearly 100 service members.

SGB works by injecting an anesthetic into a bundle of nerves located near the base of the neck. These nerves, called the stellate ganglion, are targeted using ultrasound guidance along with general anesthesia. After a one-week follow-up after their first injection, the study said that “78.6 percent of responders had an average reduction of their PTSD checklist score of 22 points.”

Game-changing relief

Dr. Eugene Lipov, a Chicago-based pain management specialist, has been using SGB to treat PTSD since 2008. Lipov knew of the nerve block’s relief for menopause-related hot flashes, and came to the conclusion that since the technique seems to restart the body’s temperature-regulating mechanism, it might also restart a PTSD patient’s overreaction to stimulus by way of interrupting the connections between the sympathetic nervous system and central nervous system.

“As a pain management specialist, I knew SGB relieved problems related to the sympathetic nerve system and thought it could work to relieve the hyperarousal characteristic of PTSD,” said Dr. Lipov.

Acceptance in the medical community

Although the procedure is showing signs of relief, it is not widely accepted as a treatment for PTSD. This is due to the fact that the disorder itself is still not fully understood. Currently, PTSD is classified as a psychiatric disorder, and physicians are reluctant to embrace a physical treatment like SGB for relief in what’s thought of as a mental health disorder.

“Pharmacotherapy and psychotherapy are only moderately helpful, at best,” said Dr. Maryam Navaie, a San Diego-based consultant. “We need more effective treatment options.”

SGB was first developed as a treatment for shoulder, neck and face pain caused by the shingles virus and complex regional pain syndrome. As far as a treatment for PTSD, the procedure usually lasts less than an hour for most patients. The complication rate is very rare, occurring in about 1.7 out of 1,000 procedures.

Current and future research

Even though the procedure isn’t a widely accepted form of treatment, SGB has been the focus of several recent studies. In October, a group of researchers from the Long Beach Veterans Affairs Healthcare System, California published results of an SGB treatment study on a group of 12 combat troops. Their results found that the procedure worked extremely well, with five out of the 12 patients feeling better afterwards and four describing SGB as a “miracle cure.”

To read more about SGB treatment for PTSD, click here: Neck Injections a Viable Treatment for PTSD, Researchers Say.


Since 1981, Havel’s has offered premium quality anesthesia needles and pain control needles for anesthesiologists, pain management specialists, physicians, doctors, hospitals and other leading medical professionals. To see Havel’s selection of anesthesia and pain control needles, please click here: Havel’s Anesthesia and Pain Control Needles.


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A Century of Innovation: Radiological Society of North America’s 2014 Annual Meeting

RSNA celebrates historical anniversary with president’s address on Sunday

RSNA President speaks to crowd at RSNA annual meeting

RSNA President N. Reed Dunnick, M.D., speaks to the crowd Sunday night at the RSNA 2014 Annual Meeting.

The Radiological Society of North America‘s 2014 Annual Meeting is currently underway in Chicago, Illinois, and this year marks a special milestone for the organization. The RSNA is celebrating their 100th annual meeting, with a focus on the past, present and future of both the organization and radiology.

RSNA President N. Reed Dunnick, M.D., addressed the crowd on Sunday and touched upon a number of topics, including the organization’s historical past and what it needs to do now in order to push radiology even further for the future.

“If we couple our historical strength in research and discovery with our new focus on delivering patient-centered care, I believe the RSNA and radiology will be well positioned for the next 100 years of service to the world,” said Dr. Dunnick.

He pointed out six distinct elements that are key to helping the field evolve and adapt for the future, but also noted that they only add up to half of the solution. The other half, he said, would come from a mix of new scientific advances with true patient-centered care.

To read more about the president’s address, click here: Innovation, Patient Focus Will Help Radiology Thrive for Next 100 Years.


Since 1981, Havel’s has offered premium quality radiology needles and biopsy needles to radiologists, doctors, hospitals and other leading medical professionals. To see Havel’s selection radiology and biopsy needles, please click here: Havel’s Radiology and Biopsy Needles.


 

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Fine Needle Aspiration and Mesothelioma: A Better Method for Diagnosis

Italian researchers conclude it as their “preferred technique”

Fine needle aspiration biopsy might be better for diagnosing mesothelioma

Researchers have found that a fine needle aspiration biopsy might be a better way to diagnose mesothelioma because it is less painful for patients.

A group of Italian researchers from the University of Catania say they have found a better way to make tissue sampling for mesothelioma easier and less painful on patients.

The technique, called a thoracic ultrasound-guided fine needle aspiration biopsy, relies on a specialized ultrasound technique designed specifically for chest imaging. Unlike a standard cutting-needle biopsy, a fine needle aspiration biopsy uses a finer needle to collect a small amount of tissue for examination. Researchers say that although samples collected from this technique are small, they are still suitable for evaluation, and the procedure itself is less traumatic for patients.

To learn more about the new research, click here: Fine Needle Biopsy: An Easier Way to Diagnose Mesothelioma?


Since 1981, Havel’s has offered premium quality radiology needles and biopsy needles for radiologists, surgeons, doctors, hospitals and other leading medical professionals. To see Havel’s selection of radiology and biopsy needles, please click here: Havel’s Radiology and Biopsy Needles.


 

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Spotlight: The Best Hospitals to Work For in Northeast America

Eight out of 10 of the best rely on Havel’s

Johns Hopkins Hospital is the best hospital to work for in northeast America

Johns Hopkins Hospital in Baltimore, Maryland leads the list of the top 10 best hospitals to work for in northeast America.

As healthcare continues to evolve, hospitals and medical centers across the country have evolved as well, adapting to the needs of 21st medical care. Recently, Healthcare Global released a top 10 list of the best hospitals to work for in northeast America. All of the hospitals represent facilities that are leading the way not only in employee satisfaction, but patient satisfaction too. They signify the best in strong credentials and a rich history of innovation, all while furthering the quality of healthcare in this country.

Topping the list was Johns Hopkins Hospital in Baltimore, Maryland, who also ranked number one on U.S. News & World Report’s list of the best hospitals in the country for 2013-14. Mount Sinai Hospital in New York City came in second, followed by Christiana Care Health System in Newark, Delaware, which currently performs in the top five percent nationwide. Rounding out the top five was Geisinger Medical Center in Danville, Pennsylvania and Lehigh Valley Hospital in Allentown, Pennsylvania at number four and five, respectively.

From the list, eight out of 10 rely on Havel’s medical products, which include our superior quality procedure needles and surgical scalpel blades. Havel’s is proud to serve some of the leading hospitals and medical centers not only in the northeast United States, but across the country as well.

To read the full list of hospitals, click here: Top 10: Best Hospitals to Work For in the Northeast United States.


Since 1981, Havel’s has offered premium quality ultrasound and procedure needles for anesthesia, pain control, radiology and biopsy, as well as sutures and surgical scalpel blades, for doctors, hospitals, veterinarians, dentists, dermatologists and other leading medical professionals. To see Havel’s selection of procedure needles, sutures and surgical scalpel blades, please click here: Havel’s Procedure Needles, Sutures and Surgical Scalpel Blades.


 

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Study Confirms Safeness of Caudal Blocks for Pediatric Surgery

Complication rate fewer than two percent for the regional anesthesia procedure

Caudal blocks safe for pediatric surgery

A new report found that caudal blocks are safe and effective for infants and children undergoing surgery.

A new report published in the October issue of Anesthesia & Analgesia shows that caudal nerve blocks, a common regional anesthesia procedure used in most pediatric surgeries, are safe and effective to use in infants and children, and carry with them very few complications and no lasting adverse effects. The study was done by Dr. Santhanam Suresh and colleagues at Northwestern University in Chicago.

According to the report, the estimated complication rate for caudal blocks was 1.9 percent, with the most common complications due to incorrect needle placement. Out of all the complications that were reported, none of them led to lasting or permanent adverse effects. Serious complications were extremely rare, occurring in only four out of the 18,650 cases used in the study.

“The current study is, to the best of our knowledge, the largest study to demonstrate safety of a single regional anesthesia technique in children,” wrote Dr. Suresh.

The data came from the Pediatric Regional Anesthesia Network (PRAN), a centralized database which collects information on practice patterns and complications of regional anesthesia techniques in children. Dr. Suresh and his colleagues analyzed the safety outcomes in 18,650 children who underwent surgery with a caudal block between 2007 and 2012. Caudal blocks were performed in 18 different children’s hospitals between the years used in the report, and according to researchers the procedure is, “likely the most common regional anesthesia technique performed in children.”

However, the report also showed a large variation in the dosage of local anesthetic used for caudal blocks. Around one-fourth of children received a dose that could cause potential toxic effects, and more studies will need to be done in order to find the optimal level of local anesthetic that should be used.

Previous studies on caudal blocks have only come from single hospitals, which made it difficult to examine the overall risks associated with the technique. The PRAN database collects data from a wide range of hospitals, making its use for this study crucial.

“This paper shows that caudal blocks for post-operative pain control are safe in children,” said Dr. Steven L. Shafer of Stanford University and Editor-in-Chief of Anesthesia & Analgesia. “It will help to guide physicians, and parents, in selecting the anesthetic that provides the best outcome for their kids.”

To read more about the new report, click here: Nerve Block Procedure is Safe in Children, Reports Anesthesia & Analgesia.


Since 1981, Havel’s has offered premium quality anesthesia needles and pain control needles for anesthesiologists, pain specialists, physicians, doctors, hospitals and other leading medical professionals. To see Havel’s selection of anesthesia and pain control needles, please click here: Havel’s Anesthesia and Pain Control Needles.


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Let’s Talk About Pain: 19 Percent of Americans Deal With Daily Chronic Pain

Survey outlines landscape of pain from across the country

Chronic pain affects a large part of the country

New research shows that nearly one in five Americans live with chronic pain on a daily basis.

A new survey published in the October issue of the Journal of Pain found that almost one out of five Americans struggle with “significant and debilitating” chronic pain on a daily basis. The poll, which included about 35,000 American households, delivers a scary but unsurprising message: if you’re living with pain in the U.S., you’re not alone.

“Going forward, it will be important to track changes in rates of persistent pain within the U.S., and compare these rates to other countries with different health care systems,” said Jae Kennedy, study author and professor of health policy and administration at Washington State University in Spokane.

For the survey, the authors analyzed data from a 2010 National Center for Health Statistics survey. Only those with continuous pain for three months were considered for inclusion. Researchers found that 19 percent of adults experience some form of daily chronic pain, and more than two-thirds of those said their pain was “constantly present.” Likewise, more than half said their pain was “unbearable and excruciating” at times.

While physically debilitating chronic pain is an issue in and of itself, the new survey also shed light on another issue: psychic pain.

“Being in pain is depressing,” said Kennedy. “Being in pain all the time is tiring. Being in pain all the time is anxiety-provoking. So it’s plausible that pain is triggering other kinds of more psychological distress.”

Of course, now the question remains: with so many Americans struggling with chronic pain, what is the best way to treat it?

Unfortunately, not all chronic pain can be treated the same way, due to the fact that it can come from many different sources.

“If it was just one thing causing pain, we might have one treatment that would work for most people,” said Bob Twillman, director of policy and advocacy for the American Academy of Pain Management. “But, given that we have millions of people with dozens, or perhaps even hundreds of causes for their pain, we can’t use a cookie-cutter approach to treating pain.”

To read more about the new survey on chronic pain, click here: Almost 1 in 5 Americans Plagued by Constant Pain, Survey Suggests.


Since 1981, Havel’s has offered premium quality pain control needles for pain specialists, physicians, doctors, hospitals and other leading medical professionals. To see Havel’s selection of pain control needles, please click here: Havel’s Pain Control Needles.


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American Academy of Dermatology Issues Statement on Rising Skin Cancer Costs

AAD president responds to a recent CDC study

AAD addresses rising cost of skin cancer treatment

The American Academy of Dermatology has released a statement concerning the rising cost of skin cancer treatment.

Recently the Centers for Disease Control (CDC) issued a study detailing the rising costs of skin cancer treatments across the country. Now, the American Academy of Dermatology (AAD) has responded to the study. In a statement from AAD President Brett M. Coldiron, MD, FAAD, the organization said the new study, “validates the role of screening and prevention programs as a mechanism to reduce the incidence of skin cancer and its related costs.”

While the statement does address the rising costs of new breakthrough melanoma treatments, these new treatments only make up a small part of the landscape. The reason overall treatment costs have gone up in recent years isn’t because all treatments are expensive, but rather because there’s been a dramatic increase in the total number of skin cancers nationwide, which then leads to a bigger number once everything is added together.

To read the full statement from the AAD, click here: American Academy of Dermatology Statement on the Cost of Skin Cancer


Since 1981, Havel’s has offered premium quality sutures and surgical scalpel blades for dermatologists, doctors, hospitals and other leading medical professionals. To see Havel’s selection of sutures and surgical scalpel blades, please click here: Havel’s Sutures and Surgical Scalpel Blades.


 

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