The Advances and Utility of Artificial Intelligence and Robotics in Regional Anesthesia: An Overview of Recent Developments

Figure 1. Performing an ultrasound-guided nerve block is a multitasking process. The image is the original work of the author.

Figure 2. A safe performance of a peripheral nerve block is characterized by multiple sequential steps, all of which must be performed adequately. The use of artificial intelligence (AI) systems allows increased precision and efficiency in this interaction.

Figure 3. Ultrasound scanner with ScanNav™ Anatomy PNB software. Intelligent Ultrasound Simulation is the trading name of MedaPhor Ltd. (ISO 13485 Certified, Copyright© 2023 Intelligent Ultrasound).

Figure 4. PNB regions and structures. PNB regions and structures color-overlayed by ScanNav™ [6]. (a) Supraclavicular-level brachial plexus: subclavian artery (red), brachial plexus nerves (yellow), first rib (blue), and pleura (purple). (b) Erector spinae plane (thoracic region): trapezius/rhomboid/erector spinae (group) muscles (green), vertebral transverse process/rib (blue), and pleura (purple). (c) Rectus sheath: rectus abdominis muscle (green), rectus sheath (orange), and peritoneal contents (brown). (d) Adductor canal: femoral artery (red), saphenous nerve (yellow), sartorius/adductor longus (green), and femur (blue). PNB: peripheral nerve block

Figure 5. Deep learning methodology of ScanNav™. ScanNav™ employs advanced deep learning using U-Net architecture (this is achieved through the use of convolutional neural networks {CNNs; ConvNets}) to identify anatomical structures in real-time ultrasound. The process involves down sampling to extract features and up sampling to refine details, with "skip connections" aiding data flow. Supervised learning involves pairs of unmodified and segmented images for each anatomical area. Over 800000 images were used [9].

Figure 6. NerveBlox® AI technology showing the boundary prediction of interscalene block. NerveBlox® AI technology showing the boundary prediction of interscalene block with predefined anatomical landmarks in the color-labeled overlay. Permission granted by NerveBlox® (SmartAlpha, Ankara, Turkey), which is an artificial intelligence software as a medical device (SaMD) with CE marking. MSM, middle scalene muscle; ASM, anterior scalene muscle; BP, brachial plexus; SCM, sternocleidomastoid muscle; AI, artificial intelligence