Method for treating premature ejaculation by high-frequency musculoskeletal ultrasound guided blade needle release of penile dorsal nerve connective tissue

Abstract

The application discloses a method for treating premature ejaculation by using high-frequency muscle-bone ultrasonic guiding razor needle to release the connective tissue of the dorsal nerve of penis, and belongs to the technical field of minimally invasive treatment of male sexual dysfunction. The method can accurately distinguish the course, branch and adjacent blood vessel level of the dorsal nerve of penis and mark the safe needle insertion area through real-time imaging of high-frequency muscle-bone ultrasound. A 0.4mm razor needle is used to perform longitudinal push-cut release in the interspace of the dorsal nerve of penis under the whole-process monitoring of ultrasound, so as to release the adhesion of the loose connective tissue under the skin and the high-tension structure. Then, transverse push-cut release is performed in the coronal sulcus area, so as to reduce the local sensory afferent excitability and prolong the ejaculation latency. The application realizes visual operation in the whole process, has small trauma and is controllable and accurate, does not damage the main stem of the nerve and the blood vessel, can stably improve the symptoms of premature ejaculation and is suitable for clinical standardization and popularization.

Description

Technical Field

[0001] This invention relates to the field of minimally invasive treatment technology for male sexual dysfunction, specifically to the soft tissue release technique of traditional Chinese medicine blade needle (small needle knife) under ultrasound visualization guidance, which is used for the clinical minimally invasive treatment of premature ejaculation. Background Technology

[0002] Premature ejaculation (PE) is one of the most common male sexual dysfunctions in andrology clinics. Epidemiological data shows that its incidence is high among adult men, seriously affecting patients' quality of life, partner relationships, and mental health. Currently, the medical community recognizes that adhesions of the connective tissue around the dorsal nerve of the penis, persistent nerve entrapment due to fascial hypertension, hypersensitivity of nerve endings, and peripheral sensory sensitization are among the core pathological mechanisms of PE.

[0003] Current clinical treatments for premature ejaculation have significant limitations: First, traditional invasive procedures such as needle release and local injections are performed blindly, as the surgeon cannot identify the needle tip position or the course of nerves and blood vessels in real time. This makes it extremely easy to accidentally damage the main trunk / branches of the dorsal penile nerve or the dorsal penile blood vessels, leading to postoperative complications such as penile numbness, hematoma, and erectile dysfunction. These procedures are not safe enough, and their effectiveness is highly dependent on the surgeon's experience, making standardized implementation difficult. Second, first-line clinical drug treatments, primarily serotonin reuptake inhibitors, can only temporarily inhibit nerve conduction and relieve symptoms, failing to address the pathological causes of nerve entrapment and adhesions. Intervening at the root cause has limited efficacy, symptoms are prone to recurrence after discontinuation, and long-term use can cause adverse reactions such as dizziness, nausea, gastrointestinal discomfort, and decreased sexual function, resulting in poor patient compliance. Thirdly, high-frequency musculoskeletal ultrasound has extremely high resolution for superficial nerves, blood vessels, and fascia layers, enabling real-time visualization of subcutaneous tissues throughout the entire process. The 0.4mm ultra-fine blade needle combines the minimally invasive nature of acupuncture with the therapeutic advantages of soft tissue cutting and release. The combination of the two has a natural advantage in treating premature ejaculation. However, there is currently no standardized, normalized, and precise operating procedure in clinical practice, which severely limits the clinical application of this technology.

[0004] Based on this, this invention addresses the core deficiencies of existing technologies by proposing a fully visualized, precise, minimally invasive, safe, controllable, and repeatable treatment method for premature ejaculation, filling a gap in clinical technology. Summary of the Invention

[0005] The core objective of this invention is to overcome the shortcomings of existing premature ejaculation treatment technologies and provide a method for treating premature ejaculation by releasing the dorsal penile nerve connective tissue with a high-frequency musculoskeletal ultrasound-guided blade needle. This method achieves full visualization of the treatment process, standardized operation, minimizes trauma, and ensures safety and controllability. It relieves abnormal nerve compression from the pathological root cause, improves premature ejaculation symptoms, and avoids the risk of nerve and blood vessel damage, forming a standardized and widely applicable clinical operation protocol.

[0006] The technical solution adopted by this invention to solve its technical problem is: A method for treating premature ejaculation by high-frequency musculoskeletal ultrasound-guided blade needle release of the dorsal penile nerve connective tissue includes the following steps: Step 1: Preoperative preparation and positioning The patient lies supine with legs naturally apart, fully exposing the penis and perineal treatment area. The treatment area is routinely disinfected with medical iodine solution, covering the base of the penis to the coronal sulcus and the surrounding perineum, with a disinfection diameter of not less than 15 cm and at least two disinfection cycles. After disinfection, a sterile drape is laid, exposing only the penile treatment area to establish a sterile operating environment.

[0007] Using standard clinical local anesthetic drugs, perform circular block anesthesia at the base of the penis. After injection, wait 3-5 minutes to confirm the anesthesia has taken effect and the patient has lost pain in the surgical area before proceeding with subsequent procedures.

[0008] Step 2: High-frequency musculoskeletal ultrasound localization scan A high-frequency linear array ultrasound probe with a frequency of 6-18MHz was used, covered with a sterile disposable probe sleeve. Sterile ultrasound coupling agent was applied to the tip of the probe to perform bidirectional continuous scanning of the dorsal side of the penis. First, perform continuous transverse scanning along the penile axis, from the base of the penis towards the coronal sulcus, to identify the penile skin, subcutaneous loose connective tissue, fascia, and tunica albuginea of ​​the corpus cavernosum layer by layer, and clearly show the number, course, and adjacent relationships of the penile dorsal artery, the main trunk and branches of the penile dorsal nerve; Then, along the long axis of the penis, a continuous longitudinal section scan of the dorsal side of the penis is performed to clearly show the continuity of each tissue layer, confirm the high-tension areas of thickened subcutaneous loose connective tissue, adhesions, and fascial contractures, and clarify the safe gaps for nerve pathways. After the scan is completed, use a sterile marker to mark the safe needle entry point, the safe gap of nerve course, and the range of release operation on the patient's body surface. The marked needle entry path avoids the main trunk and major branches of the penile dorsal blood vessels throughout the entire process to avoid the risk of injury.

[0009] Step 3: Selection of Treatment Devices Disposable sterile blade needles (small needle knives) are selected, with a fixed needle diameter of 0.4 mm, a flat blade structure at the needle tip, and a blade width that matches the needle diameter. The needle surface has length markings to facilitate confirmation of the insertion depth during the operation. Before the operation, it is confirmed that the instrument packaging is intact, within the sterility period, and without any abnormalities such as bending or blade defects.

[0010] Step 4: Longitudinal pushing and releasing on the dorsal side of the penis Under the real-time guidance of high-frequency musculoskeletal ultrasound, the operator holds a sterile blade needle and inserts it into the skin at a superficial angle of 15°-30° along the marked insertion point on the body surface, slowly advancing the needle layer by layer to the loose connective tissue layer under the subcutaneous tissue on the dorsal side of the penis; ultrasound imaging confirms that the needle tip is located in the gap between two adjacent dorsal penile nerves, maintaining a safe distance from the main nerve trunk and accompanying blood vessels, without touching the nerve peritunic and blood vessel walls; Adjust the needle angle so that it is completely parallel to the direction of the dorsal penile nerve. Use gentle and controllable force to perform a back-and-forth longitudinal pushing and cutting operation along the long axis of the nerve, focusing on loosening the thickened, adhered, and contracted subcutaneous loose connective tissue around the nerve. The pushing and cutting area is strictly limited to the preoperatively marked area of ​​adhesion and high tension. The termination standard is when tissue layers are loosened and local tension is released as seen under ultrasound. Violent operation is prohibited throughout the process, and nerves and blood vessels must not be touched.

[0011] Step 5: Lateral pushing and loosening of the coronal sulcus area After the longitudinal release of the dorsal side of the penis is completed, under real-time ultrasound monitoring, keep the needle tip in the loose connective tissue layer under the subcutaneous layer and slowly move the needle tip along the original needle path to the dorsal area of ​​the coronal sulcus; confirm the position of the needle tip again with ultrasound, confirm the deep structure away from the dense area of ​​nerve endings in the coronal sulcus, and avoid local blood vessel branches. Adjust the needle direction so that the blade is perpendicular to the direction of the dorsal nerve of the penis. Perform transverse pushing and cutting along the dorsal side of the coronal sulcus, and loosen the high-tension connective tissue under the skin of the coronal sulcus with small-amplitude fan-shaped swinging. The operation area is strictly limited to the midline area of ​​the dorsal side of the coronal sulcus, and does not extend excessively to the sides of the penis. The termination standard is to release the local tissue tension evenly, and avoid excessive loosening that may cause unnecessary tissue damage.

[0012] Step 6: Operating Procedures and Comprehensive Safety Control All operations must be performed under real-time imaging monitoring of high-frequency musculoskeletal ultrasound. Before each needle insertion, adjustment of needle tip position, and pushing, cutting, and loosening operation, the accurate position of the needle tip must be determined by ultrasound. Blind probing is strictly prohibited throughout the entire process. The only target for the release procedure is the adhered, high-tension subcutaneous loose connective tissue. Cutting, pricking, pulling, or damaging the main trunk and branches of the dorsal nerve of the penis, or the dorsal blood vessels and branches of the penis are strictly prohibited. The force applied during the pushing and releasing process should always be gentle and controllable. Violent operation is prohibited. If the patient experiences abnormal and severe pain during the operation, the operation must be stopped immediately. The needle tip position and anesthetic effect must be reconfirmed, and the possibility of the needle tip touching nerves or blood vessels must be ruled out before the operation can continue. The degree of loosening is determined by the visible loosening of adhesions and the release of local tension under ultrasound, while avoiding excessive loosening.

[0013] Step 7: Postoperative care and nursing instructions After all the operations are completed, slowly and evenly withdraw the blade needle, and immediately use sterile gauze to apply local pressure to the needle hole and the area along the needle insertion path to stop the bleeding. The pressure time should be no less than 3 minutes. After confirming that there is no active bleeding or hematoma formation in the surgical area, disinfect the needle hole again with sterile iodine swabs and cover it with sterile breathable dressing for fixation. Inform the patient of the following postoperative care guidelines and contraindications: Keep the surgical area clean and dry for 24 hours after surgery and avoid getting it wet; avoid sexual activity, masturbation and strenuous exercise for 3 days after surgery; keep the diet light and avoid spicy and irritating foods; if there is persistent swelling, increased pain, active bleeding or other abnormal conditions in the surgical area, seek medical attention immediately.

[0014] Compared with the prior art, the technical solution of this application has at least the following beneficial effects: This invention utilizes high-frequency musculoskeletal ultrasound for real-time imaging throughout the entire process, which can clearly distinguish the various layers of structures such as nerves, blood vessels, connective tissue, and fascia on the dorsal side of the penis. It can accurately locate the lesion target and the safe operation path, completely eliminating the blindness of traditional blind exploration operations and fundamentally eliminating the risk of serious complications such as nerve damage, blood vessel rupture, and hematoma formation. The entire operation is controllable.

[0015] This invention uses an ultra-fine blade needle with a diameter of 0.4 mm, which can complete the entire operation through a tiny incision the size of a needle hole. There is no need to cut the skin, no obvious postoperative scars, minimal trauma, no need for hospitalization, and patients can resume normal activities immediately after the operation. The recovery period is short, which greatly reduces the patient's treatment pain and psychological burden, and significantly improves patient acceptance.

[0016] This invention directly targets the pathological core of peripheral sensitization in premature ejaculation, precisely loosening adhesions in connective tissue and relieving nerve compression, rather than simply inhibiting sensory conduction. It corrects the abnormal pathological state from the root, resulting in stable treatment effects. It can effectively prolong ejaculation latency, improve premature ejaculation symptoms, and can be safely repeated based on the patient's recovery.

[0017] This invention establishes a standardized operating procedure for the entire process, from preoperative preparation, ultrasound positioning, release operation, safety control to postoperative care. The operation difficulty is controllable, and can be mastered by urologists, pain specialists, rehabilitation specialists, and traditional Chinese medicine physicians who have received standardized training. It is not overly restricted by equipment or venue, and is suitable for standardized clinical application in medical institutions at all levels. Attached Figure Description

[0018] To more clearly illustrate the technical solutions of the embodiments of the present invention, the drawings used in the embodiments and comparative examples will be briefly introduced below. It should be understood that the following drawings only show some embodiments of the present invention and should not be regarded as a limitation of the scope. For those skilled in the art, other related drawings can be obtained based on these drawings without creative effort.

[0019] Figure 1 This is a flowchart of the preoperative preparation and ultrasound localization process involved in the present invention; Figure 2 This invention relates to a flowchart of the ultrasonic-guided blade release operation. Figure 3 This is a flowchart illustrating the postoperative management and safety control procedures involved in the present invention; Figure 4 This is a flowchart illustrating the overall steps involved in the present invention. Detailed Implementation

[0020] To make the objectives, technical solutions, and advantages of the embodiments of the present invention clearer, the technical solutions in the embodiments of the present invention will be clearly and completely described below. Where specific conditions are not specified in the embodiments, conventional conditions or conditions recommended by the manufacturer shall apply. Reagents or instruments whose manufacturers are not specified are all conventional products that can be purchased commercially.

[0021] It should be noted that, unless otherwise specified, the embodiments and features described in the present invention can be combined with each other. The present invention will now be described in detail with reference to specific embodiments.

[0022] Example 1: This embodiment is a standard operating procedure for treating premature ejaculation using high-frequency musculoskeletal ultrasound-guided blade needle release of the dorsal penile nerve connective tissue, as detailed below: Preoperative preparation: The patient lies supine with legs naturally separated to fully expose the penis and perineum; the base of the penis to the coronal sulcus and perineum are routinely disinfected twice with medical iodine solution, covering a diameter of 15cm. After disinfection, a sterile drape is laid to establish a sterile operating environment; 2% lidocaine injection is used for circular block anesthesia of the penile base. After 5 minutes, it is confirmed that the patient has lost pain sensation in the surgical area and the anesthesia has taken effect.

[0023] Ultrasound localization: A 6-18MHz high-frequency linear array ultrasound probe is used, covered with a sterile probe sleeve, and coated with sterile coupling agent. A bidirectional scan is performed on the dorsal side of the penis: First, a transverse scan is performed, continuously scanning from the base of the penis to the coronal sulcus to identify the dorsal penile artery, the main trunk and branches of the dorsal penile nerve, and to clarify their course and adjacent relationships; then, a longitudinal scan is performed to confirm the high-tension area of ​​connective tissue adhesion and fascial thickening in the middle dorsal segment of the penis and near the coronal sulcus; a sterile marker is used to mark the safe needle entry point, the safe gap of nerve course, and the release range, and the needle entry path avoids the main trunk of the dorsal penile blood vessels throughout.

[0024] Instrument preparation: Select disposable sterile 0.4mm flat-blade needles, and confirm that the packaging is intact, sterile and effective, and that there are no bends or missing blades.

[0025] Longitudinal release: Under real-time ultrasound guidance, the blade needle is inserted into the skin at a 20° angle along the marked insertion point, and slowly advanced into the dorsal nerve space of the penis. Ultrasound confirms that the needle tip is located in the loose connective tissue layer under the skin, maintaining a safe distance from nerves and blood vessels. The needle body is adjusted to be parallel to the nerve course, and gentle back-and-forth longitudinal pushing and cutting is performed along the long axis of the nerve to release the adhesions. After ultrasound confirms that the local adhesions have been released and the tension has been relieved, the operation is stopped.

[0026] Lateral release: Under ultrasound monitoring, slowly move the needle tip along the original needle path to the subcutaneous tissue layer on the dorsal side of the coronary sulcus, confirm that the position is safe and avoid vascular branches; adjust the needle body so that the blade is perpendicular to the nerve course, and perform lateral pushing and cutting along the dorsal side of the coronary sulcus in a small-amplitude fan-shaped release. After confirming that the local tension is evenly released, stop the operation.

[0027] Safety Control: Every step of the procedure is performed under real-time ultrasound monitoring to ensure the needle tip position is always confirmed. All release procedures target only connective tissue and do not touch or damage nerves or blood vessels. The entire procedure is performed gently without any violent manipulation.

[0028] Postoperative management: Slowly withdraw the needle, apply sterile gauze to the puncture site for 5 minutes to stop bleeding, and after confirming that there is no bleeding or hematoma, disinfect the puncture site with povidone-iodine and cover it with a sterile dressing for fixation; inform the patient of the postoperative care guidelines and contraindications, and the patient can be discharged from the hospital after the operation.

[0029] Comparative Example 1: Traditional blind-probing needle release therapy for premature ejaculation Preoperative preparation: The patient is placed in a supine position. Routine disinfection, draping, penile root block anesthesia, and exposure of the treatment area are performed.

[0030] Procedure: Without ultrasound guidance, the surgeon blindly inserts the needle based on surface landmarks and clinical experience, using a 0.4mm blade needle to perform longitudinal and transverse pushing and releasing on the dorsal side of the penis and the coronal sulcus area.

[0031] Safety control: There is no real-time needle tip positioning, and it is impossible to distinguish between nerve, blood vessel and connective tissue layers. The degree of loosening is judged solely by touch.

[0032] Postoperative care: needle removal, pressure hemostasis, sterile dressing coverage, and routine nursing care.

[0033] Existing drawbacks: The operation is highly unpredictable, easily damaging the dorsal nerve and blood vessels of the penis, and the risk of complications is high; the range and force of release are uncontrollable, the therapeutic effect is unstable, and it is difficult to standardize and promote.

[0034] Example 2: This embodiment addresses premature ejaculation in patients whose ultrasound scans reveal multiple branches of the dorsal penile nerve and numerous areas of high-tension connective tissue adhesions. It employs a high-frequency musculoskeletal ultrasound-guided blade needle release technique to loosen the connective tissue of the dorsal penile nerve. The specific procedures are as follows: preoperative preparation, ultrasound localization, instrument selection, safety control standards, and postoperative management are entirely consistent with Embodiment 1. The difference lies in the following: during ultrasound localization, multiple areas of high-tension adhesions in the nerve gaps are marked, and multiple safe needle entry points are established, with each entry point's path avoiding major blood vessels. For each marked adhesion area, longitudinal pushing and releasing is performed according to the procedures in Embodiment 1. After each release, ultrasound confirms the needle tip position is safe before moving to the next adhesion area. After all longitudinal release operations are completed, transverse pushing and releasing of the coronal sulcus area is performed uniformly. The entire procedure is completed under ultrasound monitoring, and no nerve or vascular damage occurs.

[0035] Comparative Example 2: Methods of treating premature ejaculation with oral medication alone Treatment: Patients are given routine oral administration of serotonin reuptake inhibitors, at the usual clinical dosage and course of treatment.

[0036] Mechanism of action: By inhibiting neurotransmitter reuptake, it temporarily reduces the sensitivity of the central and peripheral nerves, thus prolonging the ejaculation latency period.

[0037] Administration: Oral administration at a fixed time every day. The course of treatment is carried out in accordance with clinical guidelines and does not involve any minimally invasive release procedures.

[0038] Limitations: It only symptomatically inhibits nerve conduction without addressing the underlying pathological causes of adhesions and high tension in the connective tissue surrounding the nerves; symptoms are prone to relapse after discontinuation, and long-term use may lead to adverse reactions such as dizziness, gastrointestinal discomfort, and sexual dysfunction.

[0039] Example 3: This embodiment addresses patients whose symptoms did not improve as expected after the initial treatment and require repeat treatment. It employs a high-frequency musculoskeletal ultrasound-guided blade needle release of the dorsal penile nerve connective tissue to treat premature ejaculation. The specific procedure is as follows: the interval between the repeat treatment and the initial treatment should be no less than 4 weeks. Preoperatively, a repeat high-frequency musculoskeletal ultrasound scan is required to reassess the course of the dorsal penile nerve, connective tissue adhesions and tension, and to mark new target points and safe needle insertion paths. All other preoperative preparations, release procedure specifications, safety control standards, and postoperative management requirements are completely consistent with Embodiment 1. The repeat procedure remains minimally invasive, with no additional risk of tissue damage and no complications.

[0040] Comparative Example 3: Conventional ultrasound-guided treatment for premature ejaculation, but not using a 0.4mm blade needle. Preoperative preparation: Patient positioning, disinfection, anesthesia, and ultrasound localization are the same as in this invention, and the nerve course and safety gap are marked.

[0041] Instrument selection: Use conventional small needle knife or release needle with a diameter greater than 0.4mm, which causes greater trauma and is not suitable for superficial fine release due to the mismatch of needle tip structure.

[0042] Procedure: The needle is inserted under ultrasound guidance to loosen the connective tissue in the dorsal side of the penis and the coronal sulcus area.

[0043] Defects: The instrument diameter is too large, which increases the difficulty of avoiding superficial nerves and blood vessels and reduces the minimally invasive nature; the needle tip structure is not suitable for fine cutting and can easily cause excessive loosening or tissue contusion, resulting in slower postoperative recovery and lower comfort and safety compared to the present invention.

[0044] The embodiments described above are some, but not all, embodiments of the present invention. The detailed description of the embodiments of the present invention is not intended to limit the scope of the claimed application, but merely to illustrate selected embodiments of the invention. All other embodiments obtained by those skilled in the art based on the embodiments of the present invention without inventive effort are within the scope of protection of the present invention.

Claims

1. A method for treating premature ejaculation by high-frequency musculoskeletal ultrasound-guided blade needle release of penile dorsal nerve connective tissue, characterized in that... Includes the following steps: S1 Preoperative preparation: The patient lies supine. The penile treatment area is routinely disinfected with povidone-iodine and covered with sterile drapes. Penile root block anesthesia is administered. The treatment area is exposed after the anesthesia takes effect. S2 Ultrasound Localization Scan: High-frequency musculoskeletal ultrasound is used to perform bidirectional continuous scanning of the dorsal side of the penis in transverse and longitudinal sections, clearly displaying the main trunk and branches of the dorsal nerve of the penis, the dorsal blood vessels of the penis, the loose connective tissue and fascia layers under the skin, determining the nerve course gaps and the high tension areas of connective tissue adhesions, and aseptically marking the safe needle entry point and needle entry path on the body surface, with the marked path avoiding the main blood vessel trunk throughout. S3 Longitudinal Push-cut Release of the Dorsal Side of the Penis: Using a flat-bladed needle with a diameter of 0.4 mm, the needle is inserted along the marked path under real-time ultrasound guidance, entering the gap between the dorsal nerves of the penis. The needle body is kept parallel to the nerve course, and longitudinal push-cutting, loosening and peeling are performed to release the thickened, adhered, and contracted subcutaneous loose connective tissue around the nerve. S4 Coronary Sulcus Region Transverse Pushing and Releasing: Under real-time ultrasound monitoring, the tip of the blade needle is moved along the original needle path to the coronary sulcus region. After confirming the safety of the layers, transverse pushing and fan-shaped releasing is performed perpendicular to the nerve course to release the high-tension connective tissue under the coronary sulcus. S5 Operation Safety Control: The needle tip position is monitored by ultrasound throughout the process. The target points for release are only adhesions and high-tension connective tissue. It does not cut or damage the main nerve trunks and branches, or the main blood vessel trunks and branches. The release force is based on the release of tissue tension and the loosening of adhesions. Postoperative management of S6: After the procedure is completed, slowly withdraw the needle, apply pressure to the needle hole to stop bleeding, cover with sterile dressing, and inform the patient of the postoperative care guidelines and contraindications.

2. The method according to claim 1, characterized in that, In step S2, the high-frequency musculoskeletal ultrasound uses a high-frequency linear array probe with a frequency of 6-18MHz. During the scan, the probe is first continuously transversely sliced ​​along the transverse axis of the penis from the root to the coronal sulcus to identify the number and course of nerves and blood vessels. Then, it is longitudinally sliced ​​along the long axis of the penis to confirm the areas of connective tissue adhesion and fascia thickening.

3. The method according to claim 1, characterized in that, In steps S3 and S4, the needle used is a disposable sterile flat-blade needle with a fixed needle body diameter of 0.4 mm and a blade width that matches the needle body diameter.

4. The method according to claim 1, characterized in that, In step S3, the longitudinal pushing and cutting release operation is limited to the marked high-tension area of ​​nerve interstitial adhesion. The needle body is always parallel to the nerve course, and the pushing and cutting action is gentle and back-and-forth, without touching the nerve peritunic and blood vessel wall.

5. The method according to claim 1, characterized in that, In step S4, the transverse pushing and loosening operation is limited to the subcutaneous tissue layer on the dorsal side of the coronal sulcus, without extending excessively to both sides of the penis, and avoiding the dense area of ​​nerve endings and blood vessel branches at the coronal sulcus.

6. The method according to claim 1, characterized in that, In step S5, before each needle insertion and cutting operation, the accurate position of the needle tip must be confirmed by ultrasound. Blind probing is prohibited throughout the entire process. If the patient experiences abnormal pain, the operation must be stopped immediately, and the position of the needle tip and the anesthetic effect must be reconfirmed.

Images