Use of ultrasound in needle placement in intercostal muscles: a method for increased accuracy in cadavers.

Abstract

To validate the use of ultrasound technology for the positioning and leveling of intercostal needle placement. Double-blinded experimental study. An anatomy laboratory. Two board-certified physical medicine and rehabilitation physicians, 2 first-year medical students, 1 anatomist, and 8 cadavers. Four unfixed cadavers were used for unguided needle placement, and 3 unfixed and 1 partially fixed cadavers were used for ultrasound-guided needle placement. Ultrasound-guided needle placement was then confirmed with computed tomography and blind dissection. The accuracy of needle placement. The unguided study showed needle placement in an intercostal muscle 89% of the time, but in only 15.4% of the time was the correct level sampled. In the 96 needle placements completed, the unguided needle placements had an accuracy of 8.3%, while ultrasound-guided needle placements had an accuracy of 93% (χ(2) with P<.005). Ultrasound guidance dramatically increases needle placement accuracy for intercostal nerve blocks and intercostal muscle sampling for electromyography.