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BioMed Research International
Volume 2017 (2017), Article ID 1873209, 12 pages
https://doi.org/10.1155/2017/1873209
Clinical Study

Real-Time Ultrasound/MRI Fusion for Suprasacral Parallel Shift Approach to Lumbosacral Plexus Blockade and Analysis of Injectate Spread: An Exploratory Randomized Controlled Trial

1Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
2Department of Radiology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark
3Department of Biomedicine, Faculty of Health, Aarhus University, Vennelyst Boulevard 4, 8000 Aarhus C, Denmark
4Medical Science, Faculty of Health, Aarhus University, Nordre Ringgade 1, 8000 Aarhus C, Denmark
5Department of Anesthesiology and Intensive Care Medicine, Zealand University Hospital, University of Copenhagen, Sygehusvej 10, 4000 Roskilde, Denmark
6Department of Anesthesiology, Regional Hospital of Viborg, Heibergs Alle 4, 8800 Viborg, Denmark
7Department of Anesthesiology and Intensive Care Medicine, Slagelse Hospital, Ingemannsvej 18, 4200 Slagelse, Denmark
8Department of Orthopedic Surgery, Aarhus University Hospital, Tage-Hansens Gade 2, 8000 Aarhus C, Denmark

Correspondence should be addressed to Thomas Fichtner Bendtsen

Received 11 November 2016; Accepted 29 January 2017; Published 15 March 2017

Academic Editor: Tatsuo Nakamoto

Copyright © 2017 Jennie Maria Christin Strid et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Fused real-time ultrasound and magnetic resonance imaging (MRI) may be used to improve the accuracy of advanced image guided procedures. However, its use in regional anesthesia is practically nonexistent. In this randomized controlled crossover trial, we aim to explore effectiveness, procedure-related outcomes, injectate spread analyzed by MRI, and safety of ultrasound/MRI fusion versus ultrasound guided Suprasacral Parallel Shift (SSPS) technique for lumbosacral plexus blockade. Twenty-six healthy subjects aged 21–36 years received two SSPS blocks (20 mL 2% lidocaine-epinephrine [1 : 200,000] added 1 mL diluted contrast) guided by ultrasound/MRI fusion versus ultrasound. Number (proportion) of subjects with motor blockade of the femoral and obturator nerves and the lumbosacral trunk was equal (ultrasound/MRI, 23/26 [88%]; ultrasound, 23/26 [88%]; ). Median (interquartile range) preparation and procedure times (s) were longer for the ultrasound/MRI fusion guided technique (686 [552–1023] versus 196 [167–228], and 333 [254–439] versus 216 [176–294], ). Both techniques produced perineural spread and corresponding sensory analgesia from L2 to S1. Epidural spread and lidocaine pharmacokinetics were similar. Different compartmentalized patterns of injectate spread were observed. Ultrasound/MRI fusion guided SSPS was equally effective and safe but required prolonged time, compared to ultrasound guided SSPS. This trial is registered with EudraCT (2013-004013-41) and ClinicalTrials.gov (NCT02593370).