From the emergency room to the sports clinic, point-of-care ultrasound (POCUS) has served as a revolutionary diagnostic imaging alternative to MRI and CT for patients seeking pain relief. Emergency physicians can ask patients to use the transducer of a POCUS machine to show exactly where they feel pain, alleviating the common struggle of patients describing their pain and expediting a diagnosis.
Point-of-care ultrasound guidance for pain management drives double-digit growth for Anesthesia and MSK applications in 2018
From the emergency room to the sports clinic, point-of-care ultrasound (POCUS) has served as a revolutionary diagnostic imaging alternative to MRI and CT for patients seeking pain relief. Emergency physicians can ask patients to use the transducer of a POCUS machine to show exactly where they feel pain, alleviating the common struggle of patients describing their pain and expediting a diagnosis. Outside of emergency medicine, dynamic imaging over a period of physiotherapy sessions allows for easier monitoring of progress as well as optimization of a patient’s musculoskeletal (MSK) rehabilitation plan. Perhaps the most significant use of POCUS for pain management in recent years has been for procedural guidance, specifically needle guidance for nerve block and regenerative medicine injections.
Nerve blocks will drive major anesthesia growth in advanced markets
In 2018, point-of-care (POC) unit shipments for perioperative and regional anesthesia (RA) grew nearly 15% year-over-year (YoY) in both North America and Western Europe, and continued growth is expected from 2019 to 2023. In the United States, ultrasound-guided nerve blocks for pain management post-surgery, as well as in emergency departments, have become powerful tools for combatting the American opioid crisis and have driven major perioperative and regional anesthesia unit shipment growth. In many Western European countries, using POCUS for nerve blocks is highly encouraged because of reductions in cost, improved rates of procedural success, and shortened lengths-of-stay. These factors are driving the product mixture shift away from general anesthesia and towards perioperative and regional anesthesia. By 2023, ultrasound-guided RA will be considered an ideal alternative to the prescription of opioids for pain management, and POCUS equipment for perioperative anesthesia will be commonplace in every North American and Western European post-anesthesia care unit.
What will it take for ultrasound-guided nerve blocks to become the gold standard everywhere?
Compared to “blind” or “landmark” techniques and even nerve stimulation, studies have concluded that ultrasound needle guidance leads to higher rates of successfully hitting the target vein for peripheral nerve blocks. Many midrange POC compact ultrasound systems, such as the Fujifilm SonoSite SII, are especially tailored for muscle, nerve, and vasculature imaging and include settings for popular nerve block procedures. Despite the growing number of POCUS users in advanced markets of North America and Europe who consider ultrasound-guided anesthesia the gold standard method, widespread adoption is not present in Asia Pacific. The main barriers to growth in this region are the slow pace of adoption of new ultrasound technology in mature markets and the limited access to ultrasound equipment and training in emerging markets. A potential driver for adoption in emerging markets would involve local manufacturers, such as Mindray and Sonoscape, driving increased unit shipments with lower prices, but significant growth in this region would depend on those manufacturers also providing POCUS training and other educational resources.
North America is embracing ortho-biologics and regenerative medicine
An education outreach approach similar to Philips’s Ultrasound Guided RA & PM Education Portal could potentially be used to drive wider acceptance of other new POC applications, such as regenerative medicine, in emerging markets. In MSK practices, biologics and regenerative medicine are used to encourage healing of injured or non-functional tissue. In advanced markets, younger populations are eager for less-invasive alternatives to joint replacement surgeries and non-traditional therapies, making biologics and regenerative medicine increasingly appealing options. Ultrasound guidance for needle visualization has quickly become a crucial part of the rise of regenerative medicine. When injecting highly valuable biologics such as platelet rich plasma (PRP) or stem cells, accuracy is paramount, thus making needle guidance solutions a priority for MSK ultrasound manufacturers. Konica Minolta’s “blue needle” Simple Needle Visualization algorithm on SONIMAGE ultrasound systems allows users to more easily identify and precisely direct the tip of the needle. Needle guidance technology like this has contributed to the nearly 10% YoY growth for MSK rehabilitation unit shipments and increased the popularity of ultrasound-guided injections among North American physical therapists and sports medicine physicians.
Why have other advanced markets been uncertain about regenerative medicine?
Like all POCUS applications, wider adoption of MSK ultrasound comes with reimbursement concerns, but there are also some unique barriers to more widespread growth. In advanced Western European and Asia-Pacific markets, a significant amount of skepticism surrounding the efficacy of regenerative medicine exists. In Western Europe, professional athletes have popularized the use of biologics within sports medicine, but the greater MSK community is reluctant to widely adopt the treatment before it has been thoroughly scrutinized by the academic research community. In advanced Asia-Pacific markets, most of the aging population seek traditional MSK treatments for pain management despite the invasiveness. Joint replacement surgery was in high demand in 2018, driving nearly 11% YoY growth for MSK orthopedics unit shipments in the Asia-Pacific region. Expanding the use of regenerative medicine and ortho-biologics into the region will require a successful education campaign to demonstrate its positive role in pain management.
As the academic research community continues to develop new treatments and technology for pain management, additional POCUS use cases for procedural guidance will be developed. Alongside the growing enthusiasm for POCUS among physicians, these advancements will make ultrasound equipment and features for Anesthesia and MSK even more in demand in the future.
Marianne Clare Reyes contributed to this article. She is a research intern at IHS Markit.