Transducers for regional anesthesia

[pgg]

The OB department the next hallway over is ordering a new SonoSite machine and asked me if I wanted them to pick up any transducers for our nerve blocks. Naturally, I said yes.

We don't have our own u/s machine so we've been borrowing theirs when we need one, just making do with their baby-scanning probes.

Anyone care to eyeball the model #s / freq range of their favorite PNB transducers for me? I haven't had access to any dedicated regional ultrasound gear since residency and I don't remember the details.

I'm thinking of something narrow in the 7-15 MHz range for IS/supraclavicular blocks and something wider in the 5-10 MHz range for fem/sciatic/popliteal blocks.

Thanks.

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[periopdoc]

Which machine are they getting and which probe are they getting with it?

Hopefully it is the M-Turbo.

If it is the M-OB/GYN Office, you should contact Sonosite 877-290-4911 email to see if it will work with probes other than the C60x and the ICTx. I assume there is a difference in the software or something that allows them to market this machine to the OB offices as a different machine than their premier M-Turbo. Please report back as I am curious what the difference between the two machines is.

The best probe for your application is either the

L25x

or the SLAx.

Both are 13-6 MHz 25-mm broadband linear array probes with scan depths of 6 cm. This will give you 99% of your blocks. Some people like the hockey stick style SLAx. I personally prefer the L25x style probe. There is also the HFL38x which is essentially the same probe, but with a larger footprint. Personally, I like the smaller probes. Go here to see the transducers available for the M-Turbo.

If you need a deeper view you can use the C60x (5-2MHz, curved array, 30cm scan depth) probe that the OB dept will likely be getting, or pick up a C11x (8-5MHz, curved array, 10cm scan depth) probe. Honestly, the money for C11x is probably best spent elsewhere as you won't be using it much.

Good luck.

- pod

 

[sevoflurane]

+1.

I use this 99.9999% of the time:

Versatile little guy with many applicaitons.

 

[pgg]

Thanks sevo & pod.

Which machine are they getting and which probe are they getting with it?

Not yet determined, still at the earliest stage of the government procurement process. It's possible that the machine they get will be a GE or Philips or Siemans or something else, but Sonosite seems most likely.

They were looking at the M-OB/GYN model (among others) - I'll ask about the compatibility issue.

The best probe for your application is either the [L25x or the SLAx]

Both are 13-6 MHz 25-mm broadband linear array probes with scan depths of 6 cm. This will give you 99% of your blocks. Some people like the hockey stick style SLAx. I personally prefer the L25x style probe. There is also the HFL38x

I'd been eyeballing the HFL38x and HFL50x.

If you need a deeper view you can use the C60x (5-2MHz, curved array, 30cm scan depth) probe that the OB dept will likely be getting, or pick up a C11x (8-5MHz, curved array, 10cm scan depth) probe. Honestly, the money for C11x is probably best spent elsewhere as you won't be using it much.

We've been using their fat curved low freq probe for leg blocks and it's been OK.

The priority is a high freq small probe for the neck. I do most of my blocks nerve stim only and I get a little puckered semi-blindly putting a tuohy in the neck for an IS catheter ... it'd be useful for vascular access too. For deeper views I bet we'll end up making do with their low freq probe but I'll ask for a mid freq probe like the C11x too.

 

[periopdoc]

I'd been eyeballing the HFL38x and HFL50x...

The priority is a high freq small probe for the neck.

I would highly recommend the smaller footprint of the two probes that I mentioned. I can't think of an instance where I have wished for or used the larger footprint of the HFL38x on the machines that have both probes when doing a nerve block. I have frequently wished for the smaller footprint of the L25x on the machine that only has the HFL38x, especially when doing blocks in the neck.

I do use the larger footprint transducer for IJ cannulation, but that is only because the machines in the OR, dedicated to cannulation, only have the larger probe. I suspect the smaller one would be just fine, I just haven't tried it.


Regarding the question of L25x bs SLAx, you will have guys like Sevo who swear by the SLAx and guys like me that swear at them. I can't seem to balance the SLAx to save my life. I could be wrong, but I believe that you can outfit the L25x with a needle guide, but you cannot with the SLAx. This really isn't critical for our applications.

-pod

 

[kmurp]

I second the recommendation for the smaller of the two sonosite probes. We bought the larger one at the recommendation of the sonosite rep and it's cumbersome in the neck. It looks to me like the smaller probe is similar to the one GE provides on their machines. (we have one of them as well). By the way, in my opinion, the GE offers a better more detailed picture but the sonosite is more idiot proof.

 

[sevoflurane]

We have 3 of these on wheels. Not sure about the other brands, but you can take pics that are wirelessly linked to your patient encounter/MRN #. No need to print a picture if you have the ability to send pics electronically. It is a pretty brainless system and I like the quality of the imges. I think you can fit up to 3 transducers.

I hear you on the tuohy and IS/Supraclav catheters. SOOOOO much nicer to see the tip.

 

[sevoflurane]

I would highly recommend the smaller footprint of the two probes that I mentioned. I can't think of an instance where I have wished for or used the larger footprint of the HFL38x on the machines that have both probes when doing a nerve block. I have frequently wished for the smaller footprint of the L25x on the machine that only has the HFL38x, especially when doing blocks in the neck.

I do use the larger footprint transducer for IJ cannulation, but that is only because the machines in the OR, dedicated to cannulation, only have the larger probe. I suspect the smaller one would be just fine, I just haven't tried it.


Regarding the question of L25x bs SLAx, you will have guys like Sevo who swear by the SLAx and guys like me that swear at them. I can't seem to balance the SLAx to save my life. I could be wrong, but I believe that you can outfit the L25x with a needle guide, but you cannot with the SLAx. This really isn't critical for our applications.

-pod

This is correct. However, I don't ever use a needle guide... it's an extra step that I don't think you need IMHO.

 

[periopdoc]

This is correct. However, I don't ever use a needle guide... it's an extra step that I don't think you need IMHO.

Agreed. Never used one, never seen one used, not quite sure why anyone would want to, but in the spirit of full disclosure.

- pod

 

[pgg]

If it is the M-OB/GYN Office, you should contact Sonosite 877-290-4911 email to see if it will work with probes other than the C60x and the ICTx. I assume there is a difference in the software or something that allows them to market this machine to the OB offices as a different machine than their premier M-Turbo. Please report back as I am curious what the difference between the two machines is.

Our dedicated OB machine running the Endovaginal probe and Curved Array probe does not accommodate the linear probes for Nerve Blocks and Vasc Access. This system is the M-OB version of the M-Turbo.

Getting quotes for the M-Turbo and various probes. Government gears grind slowly but progress is being made. Thanks again everyone.