The Use of a New Device-Assisted Needle Guidance versus Conventional Approach to Perform Ultrasound Guided Brachial Plexus Blockade: A Randomized Controlled Study

Amaresh Vydyanathan,1 Priya Agrawal,2 Naveen Shetty,3 Singh Nair,1 Nancy Shilian,4 Naum Shaparin1 1Department of Anesthesiology and Pain Management, Montefiore Medical Center, Bronx, NY, USA; 2Sutter Health System, Oakland, CA, USA; 3Department of Anesthesiology, New York University, New York, NY, USA; 4Department of Family Medicine, Mount Sinai South Nassau Hospital, Oceanside, NY, USACorrespondence: Amaresh Vydyanathan, 1250 Waters Place, Tower II, 8th Floor, Bronx, NY, USA, Tel +216-702-5965, Fax +929-263-3950, Email [email protected]: Ultrasound guidance during nerve blockade poses the challenge of maintaining in-plane alignment of the needle tip. The needle guidance device maintains needle alignment and assists with in-plane needle visualization. The purpose of this study is to evaluate the utility of this device by comparing procedure performance during brachial plexus blockade with the conventional approach.Methods: After the Institutional Review Board approval and obtaining informed consent, 70 patients receiving either interscalene or supraclavicular nerve blocks were randomly assigned into 2 groups, a conventional approach versus utilizing the needle guidance device. An independent observer recorded: total procedure time; needle insertion time; number of unplanned redirections; and number of reinsertions. Additionally, physician satisfaction and ease of needle visualization were assessed.Results: Data from seventy patients were analyzed. The median [25th percentile-75th percentile] time to complete the block by the device assisted needle guidance group was 3 (2– 3.75) minutes and 4 (3– 6) minutes in the conventional approach group (p < 0.001). Additionally, subgroup analyses were performed in the supraclavicular block and interscalene block. Supraclavicular blockade, needle insertion time (median [25th percentile-75th percentile] in seconds) (106 [92– 162] vs 197 [140– 278]), total procedure time (3 [2– 3] vs 4.5 [4– 6] in minutes) and unplanned needle redirections (2 [1– 5] vs 5.5 [3– 9]) were significantly lower in needle guidance group (p < 0.001). With interscalene blockade, needle insertion time (86 [76– 146] vs 126 [94– 295]) and unplanned needle redirections (2 [1– 3] vs 4 [2– 8.5]) were significantly lower with needle guidance (p < 0.001), but total procedure time was similar. All the physicians reported that they would use the needle guidance again, and 90% would prefer it for in-plane blocks.Conclusion: Performing regional blocks using the needle guidance device reduces needle insertion time and unplanned needle redirections in brachial plexus blockade. Moreover, physician satisfaction also improved compared to the use of the conventional technique.Keywords: brachial plexus blockade, ultrasound guidance, peripheral nerve blockade, needle guidance, needle visualizatio

Defining Personas of People Living with Chronic Pain: An Ethnographic Research Study

Melissa Cullens,1 Cyan James,1 Meran Liu,1 Amaresh Vydyanathan,2– 4 Naum Shaparin,3– 5 Michael Schatman,6,7 Jacob Hascalovici2,3,5,8 1Clearing Relief Labs Inc., New York City, NY, USA; 2Relief Medical Group P.A, New York City, NY, USA; 3Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY, USA; 4Multidisciplinary Pain Program, Montefiore Medical Center, Bronx, NY, USA; 5The Arthur S. Abramson Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Bronx, NY, USA; 6Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Grossman School of Medicine, New York City, NY, USA; 7Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York City, NY, USA; 8Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USACorrespondence: Jacob Hascalovici, Relief Medical Group P.A, 169 Madison Ave, Suite 2412, New York City, New York City, 10016, USA, Email [email protected]: Pain is the leading reason for which people seek medical care in the United States, and chronic pain (CP) affects approximately 50 million people in the US Pain perception is deeply personal, is highly correlated with behavioral and emotional disorders, and is greatly influenced by physiological and environmental factors. The patient-provider relationship can have profound implications for clinical outcomes within the context of treating CP. However, limited access to pain specialists, the complex nature of many CP-causing conditions, the absence of instruments for objective pain measurement, and the need to foster a trust-based patient-provider relationship throughout treatment pose unique challenges.Objective: To support a more optimal CP care delivery system that leverages a healthy therapeutic patient-provider relationship, we systematically gathered deeper knowledge of the behaviors, interpersonal dynamics, home environment, values, and mindsets of people who experience CP.Methods: We employed ethnographic research methods to collect and analyze data on views, habits, strategies, attitudes, and life circumstances of a range of participants living with CP. We aggregated, analyzed, and summarized participant data to identify trends and similarities.Results: Our findings suggest that patients can be broadly categorized into five predominant pain typologies, or “personas”, which are characterized by respective symptom durations, care management preferences, values, communication styles, and behaviors.Conclusion: Identifying CP personas may enhance the ability to personalize CP care and help foster more robust therapeutic relationships, which may lead to greater trust, improved patient satisfaction, and better clinical outcomes.Keywords: chronic pain, personas, biopsychosocial, doctor–patient relationshi