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Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia

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Intravenous regional anesthesia or the Bier block technique is used to anesthetize a specific limb or extremity. It uses exsanguinated or blood-drained vessels to transport local anesthetics or LAs to the peripheral nerve trunks. Lidocaine without vasoconstrictors like epinephrine is most commonly used for this technique. Other drugs used are prilocaine, ropivacaine, and chloroprocaine. Bupivacaine is not recommended for this technique due to its high cardiac toxicity.
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Biplane Utilization Improves Accuracy for Peripheral IV Placement.

Ge Qu¹, Amanda M Frantz¹, Cynthia S Garvan¹

¹Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA.

Journal of Clinical Ultrasound : JCU

|February 27, 2025

Summary

This summary is machine-generated.

Biplane ultrasound imaging significantly reduces needle redirections and posterior vessel wall penetrations during intravenous (IV) catheter placement in a phantom model. This suggests biplane imaging offers an advantage for ultrasound-guided IV access.

Keywords:

backwall biplane butterfly iQ peripheral IV short‐axis

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Area of Science:

Medical Imaging
Ultrasound Technology
Vascular Access

Background:

Ultrasound is advantageous for deep peripheral vein access.
Short-axis and long-axis views offer distinct needle-vessel spatial information.
Biplane imaging combines both views for simultaneous visualization.

Purpose of the Study:

To assess the advantage of biplane imaging over single-plane imaging for intravenous (IV) catheter placement.
To evaluate the impact of biplane imaging on procedural outcomes in a phantom model.

Main Methods:

Thirty participants performed IV catheter placements in a phantom using randomized biplane or single-plane ultrasound views.
Statistical analysis included Wilcoxon signed-rank tests and Spearman correlation.
Prior experience and comfort with ultrasound-guided IVs were assessed.

Main Results:

Biplane imaging resulted in significantly fewer mean needle redirections (1.5 vs. 2.1, p=0.002).
Biplane imaging led to fewer mean posterior vessel wall penetration complications (0.1 vs. 0.3, p=0.03).
No significant difference was found in time to successful placement or number of attempts.

Conclusions:

Biplane ultrasound imaging demonstrated an advantage in reducing needle manipulations and complications during IV catheter insertion in a phantom.
While not impacting placement time, biplane imaging shows promise for improving procedural safety.
Further research is required to determine the transferability of these findings to clinical patient care.