Background and Objectives
Traditionally many pain interventions ( acute and chronic)  were performed using landmark techniques.  This resulted in considerably high failure rate and complications with failed SA 1-17% out 700,000 central neuraxial blocks performed annually , 19% failure rate to cannulate vein on CVC insertions  (USA 5 million and UK 2 million every year), 10% complication rate on CVC insertion ( include puncturing an artery, nerve injury, pneumothorax, and incorrect positioning of the catheter), 10 – 23% peripheral nerve blocks in addition to   reports of vascular puncture  in 5.7% and 6.6% for femoral and sciatic catheters, respectively. To mitigate this peripheral nerve stimulation and  fluoroscopy were used. The advent of ultrasound has revolutionized this. Hence, NICE (UK) and AHRQ (USA) recommend its use. Yet, ultrasound requires additional psychomotor skills requiring variable periods of training and a time dependent ‘learning curve’. 
Also, variations in technical accuracy exist despite the use of ultrasound. Assist, devices are  suggested to improve this. Our aim was to design a simple, versatile, portable, reliable ultrasound needle guide device that would allow better image optimization, aid training, facilitate procedures and improve success rate, particularly in difficult scenarios in an ageing population with multiple comorbidities and anatomic variations.
Methods
A  collaboration between mechatronic engineers from Loughborough University and a  group of medical experts from University Hospitals of Leicester developed the Loughborough guidance system composed of pre-puncture and real time guides. It aids pre puncture scans and subsequent adjustment of needle and allows improved performance of real time in-plane and out-of-plane procedures. Unique to it is the development of a mobile application software that calculates the needle depth and angle of insertion.








Results
Usability tests among established clinicians established ease of use. A cadaveric study comparing experienced clinicians and trainee doctors confirmed this, both achieving 100% first time hit rate for in-plane and out-of-plane real time procedures with the latter taking 37% more time. Average number of attempts for pre-scan epidurals was 1.14 seconds for experienced and 1.35 seconds for trainees.
Conclusion
The use of ultrasound allows a safer and more accurate  performance of procedures that had traditionally been performed by landmark techniques or other imaging modalities, offering a dynamic, real time, portable and radiation free alternative. However, this this requires a variable degree of training with yet variating in subjective skill and dexterity. Loughborough guides are innovative guides that allow accurate performance of a variety of ultrasound guided pain procedures
References
Fettes et al. BJA: British Journal of Anaesthesia, Volume 102, Issue 6, 1 June 2009, 739–748.
The Royal College of Anaesthetists Third National Audit Project Working Group First published: 16 January 2008

ULTRASOUND GUIDED PAIN INTERVENTIONS USING THE LOUGHBOROUGH GUIDES: NOVEL GUIDES FOR PRE-PUNCTURE AND REAL TIME PROCEDURES