Anesthesia Alert: Three Questions to Ask About Ultrasound

Budget, expertise level and patient profile determine what’s best for you.

Gone are the days of needing to use nothing but landmarks and intuition for an anesthesia provider to place a needle near a nerve before injecting a local anesthetic to block surgical pain before it happens.

Now, trained professionals use ultrasound technology to get closer to the nerves and create longer-lasting, more successful blocks that significantly improve outcomes. Regional anesthesia use reduces the potential effects of general anesthesia, such as postoperative nausea and vomiting.

Opioid use is reduced, which makes for quicker recoveries and faster safe discharges. There can also be fewer blood clots and less loss of blood in some procedures, reduced post-op pain and infection rates, as well. Payers have taken notice and are beginning to prefer it — as evidenced by the fact that nerve blocks are also revenue generators that can be billed as part of the anesthesia pro fees and in facility fees as well.

But which device should you purchase? With technology improving and your options growing, here are some considerations to help you get started.

1. What’s your budget?

As the saying from leadership groups across the country goes, “The answer is, ‘Money.’ Now what’s the question?” Whether you’re buying a traditional portable laptop-style ultrasound device with at least two probes or want to be part of the movement toward handheld devices, you must first assess what you can afford.

Standalone laptop ultrasounds can range from $25,000 to $60,000. Handheld models that employ piezoelectric pixel technology, too, can cost $60,000 and $15,000 per probe. Other handhelds, however, employ semiconductor technology, use a single probe head for multiple uses and can be purchased for $2,000 to $9,000.

The laptop styles can essentially handle any block you need to perform in an ASC or HOPD setting, from complex orthopedic of podiatry procedures to any sort of general surgery.

The handhelds, which attach to your phone, are versatile and vary in quality based on how expensive they are. It all comes down to what sort of fidelity you need for what you’re doing and how much that fidelity will impact your ability to block the patient, which of course determines the outcome of the block.

If your budget is $10,000, you might want to consider a new handheld over a used laptop, because the fidelity of a top-of-the-line handheld will be better than an older laptop-style machine. Realize, however, that a less expensive model usually ages out earlier than more expensive ones. Also keep in mind that as the use of ultrasound continues to generate revenue, these machines may well generate enough money to pay themselves off in a short period of time from the facility fee alone.

Regional anesthesia is a win-win because of the revenue it generates on top of the wide array of clinical benefits that improve the care you provide your patients. In addition to expanding the pool of patients who can have same-day surgery in the first place, these blocks are also billable. It’s not six or seven figures a year, but it’s substantial.

Payers have taken notice and are beginning to prefer it — as evidenced by the fact that nerve blocks are also revenue generators that can be billed as part of the anesthesia pro fees and in facility fees.

This prospect makes investing in the best equipment relatively safe, because you’re very likely to get your money back.

2. What is the skill level of your anesthesia provider?

While handhelds have varying degrees of quality, they’re never quite as good as a high-quality standalone device. So another determinant of your purchasing decision is how skilled the anesthesia providers at your facility are.

If you’ve got a very deep target to anesthetize, for example, a provider who is really good may be able to do a successful block with a mid-tier handheld, while someone with less experience is going to rely more on getting a better image. For the latter, a standalone would be more appropriate.

The ability to use ultrasound devices depends on provider training and experience. The pre-ultrasound practice of using landmarks and twitch monitors was more intuitive, while ultrasound is less so. It takes a lot of practice to fully grasp how ultrasound allows you to get a 2D image to represent a 3D structure than place a needle into a very narrow space right next to the nerve before the local is injected to anesthetize the area.

Practitioners who aren’t experienced on ultrasound, work at ASCs and want to begin using it must be motivated to get trained to use the devices and be willing to take the associated risks for the new rewards of better outcomes and extra reimbursements. As facilities decide how much to spend for higher level of fidelity in their images, they need to assess their anesthesia providers’ current capabilities — and whether they’re willing to learn something new and advanced.

Facility leadership should be up front with practices about the expectations of their skill levels and, if they are proficient with ultrasound, include them in the trialing process before purchasing new equipment.

3. What’s your patient profile?

Larger patients, either those with high BMIs or perhaps an athlete with very large legs, will require blocks using curvilinear probes with large footprints for procedures that will call for deeper blocks.

Orthopedic shops with rigid patient selection criteria that include BMI thresholds could get away with a handheld, but laptop models would be more appropriate for more open-minded facilities that have larger patients.

The higher-fidelity machines will make it much easier to achieve successful block outcomes for these patients. The same holds true when performing transabdominal plane or quadratus lumborum blocks before laparoscopic procedures for this patient population.

The use of regional anesthesia is growing, but it’s still underused in many areas of the country. Ultrasound assistance can speed up that growth, giving patients the increased access to much-needed nerve blocks and their many benefits. OSM