Novel approaches to needle tracking and visualisation

The accuracy and reliability of ultrasound are still insufficient to guarantee complete safe nerve block for all patients. Injection local anaesthetic close to, but not touching, the is key outcomes, exact relationship between needle tip epineurium difficult evaluate, even with ultrasound. Ultrasound has resolution, tissues discern due acoustic impedance needles more see increased angulation. limitations have shifted focus innovation towards bio-markers that help detect position by utilising physical properties tissues, (e.g. pressure, electrical, optics, elastic). Although most at laboratory stage results as yet only available from phantom or cadaver studies, clinical trials imminent. For example, fine optical fibres placed within lumen can measure pressure. Electrical differentiates intraneural perineural placement. A new tracker a piezo element embedded its distal end tracks in-plane out-of-plane blue/red green circle depending on relative location beam. Micro-ultrasound in development. Early images using 40MHz anaesthetised pigs reveal muscle striation, distinct 30–40 fascicles > 75 micron diameter. next few years will technological revolution tip-tracking technology potential improve patient safety and, doing so, change practice.