Physical properties and functional alignment of soft-embalmed Thiel human cadaver when used as a simulator for ultrasound-guided regional anaesthesia

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Presentation transcript:

Physical properties and functional alignment of soft-embalmed Thiel human cadaver when used as a simulator for ultrasound-guided regional anaesthesia S Munirama, R Eisma, M Columb, G.A. Corner, G.A. McLeod British Journal of Anaesthesia Volume 116, Issue 5, Pages 699-707 (May 2016) DOI: 10.1093/bja/aev548 Copyright © 2016 The Author(s) Terms and Conditions

Fig 1 Example of neck dissection in soft-embalmed Thiel cadaver. Brachial plexus roots can be seen between the anterior and middle scalene muscles. Abbreviations: AS, anterior scalene; C5, C6, C7, anterior rami; CCA, common carotid artery; MS, middle scalene; O, omohyoid muscle; PN, phrenic nerve crossing anterior scalene muscle; VN, vagus nerve. British Journal of Anaesthesia 2016 116, 699-707DOI: (10.1093/bja/aev548) Copyright © 2016 The Author(s) Terms and Conditions

Fig 2 Strain and brightness characteristics in soft-embalmed Thiel cadaver and patients during interscalene and femoral nerve block. Column (a) shows interscalene block in the soft-embalmed Thiel cadaver; column (b) interscalene block in a patient; column (c) femoral block conducted in the soft-embalmed Thiel cadaver; and column (d) femoral block conducted in a patient. Upper images are the standard B-mode image, with abbreviations: AS, anterior scalene; FA, femoral artery; FN, femoral nerve; MS, middle scalene. Middle images highlight the femoral nerve in blue and the spread of fluid in yellow. Lower coloured elastograms show tissue displacement associated with a 5 ml bolus of injectate in both soft-embalmed Thiel cadaver and patients. Increased strain is associated with progression from yellow to orange to red. Fluid spread is smaller than strain because tissues are displaced secondary to fluid injection. British Journal of Anaesthesia 2016 116, 699-707DOI: (10.1093/bja/aev548) Copyright © 2016 The Author(s) Terms and Conditions

Fig 3 B-Mode and shear wave elastography (SWE) ultrasound images of interscalene nerve roots and median nerves in Thiel-embalmed soft cadaver and human. Column (a) shows interscalene nerve roots in the soft-embalmed Thiel cadaver; column (b) interscalene nerve roots in a patient; column (c) median nerve in the soft-embalmed Thiel cadaver; column (d) median nerve in a volunteer; column (e) sciatic nerve in the soft-embalmed Thiel cadaver; and column (f) sciatic nerve in a volunteer. Upper images are SWE and lower images are standard B-mode ultrasound. Within the SWE images, the coloured area gives a pictorial representation of Young's modulus. For both interscalene nerve roots and sciatic nerves, Young's modulus gradient is represented as follows: dark blue, 0–7 kPa; light blue, 7–14 kPa; green, 14–21 kPa; yellow/orange, 21–28 kPa; and red, 28–35 kPa. For median nerve, Young's modulus gradient is represented as follows: dark blue, 0–18 kPa; light blue, 18–36 kPa; green, 36–54 kPa; yellow/orange, 54–72 kPa; and red, 72–90 kPa. Regions of interest used to measure Young's modulus are not shown. Coloured areas correspond to stiff interscalene nerve roots, median nerve, sciatic nerve, and stiff connective tissue in both the soft-embalmed Thiel cadaver and humans. Colour maps indicate stiffness of tissues within similar ranges in Thiel cadaver and humans. Note that the order of stiffness in the Thiel cadaver is the same as in humans: median>interscalene>sciatic. Abbreviations: AS, anterior scalene; C5, C6, anterior rami; MN, median nerve; MS, middle scalene. British Journal of Anaesthesia 2016 116, 699-707DOI: (10.1093/bja/aev548) Copyright © 2016 The Author(s) Terms and Conditions

Fig 4 B-Mode images from a study investigating learning curves of anaesthetic trainees. Twenty trainees performed left-sided interscalene block at the same site, in the same cadaver throughout a 10 day period. Column (a) represents images obtained on day 7, and column (b) represents images obtained on day 10. The upper images are right-side control images of the interscalene region. The middle images show left-side interscalene region recorded at 09.00 h on days 7 and 10. The lower images show the left-side interscalene image at 15.00 h on day 7 and day 10 after 120 needle insertions and injection of at least 60 ml Thiel embalming fluid each day. White arrow indicates path of block needle. Images show a small accumulation of fluid in the medial scalene muscle compared with the right-sided control, but retention of nerve root, anterior scalene, and superficial tissue morphology. Between day 7 and day 10, at least 150 ml of fluid was injected but minimal change present in the middle scalene muscle. Abbreviations: C5, C6, anterior rami; SA, Scalenus anterior; SM, Scalenus medius. British Journal of Anaesthesia 2016 116, 699-707DOI: (10.1093/bja/aev548) Copyright © 2016 The Author(s) Terms and Conditions

Video 1 British Journal of Anaesthesia 2016 116, 699-707DOI: (10.1093/bja/aev548) Copyright © 2016 The Author(s) Terms and Conditions

Video 2 British Journal of Anaesthesia 2016 116, 699-707DOI: (10.1093/bja/aev548) Copyright © 2016 The Author(s) Terms and Conditions

Video 3 British Journal of Anaesthesia 2016 116, 699-707DOI: (10.1093/bja/aev548) Copyright © 2016 The Author(s) Terms and Conditions

Video 4 British Journal of Anaesthesia 2016 116, 699-707DOI: (10.1093/bja/aev548) Copyright © 2016 The Author(s) Terms and Conditions