Cadaveric ultrasound imaging for training in ultrasound-guided peripheral nerve blocks: Upper extremity (original) (raw)
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Ultrasound guidance for deep peripheral nerve blocks: a brief review
Anesthesiology research and practice, 2011
Nerve stimulation and ultrasound have been introduced to the practice of regional anesthesia mostly in the last two decades. Ultrasound did not gain as much popularity as the nerve stimulation until a decade ago because of the simplicity, accuracy and portability of the nerve stimulator. Ultrasound is now available in most academic centers practicing regional anesthesia and is a popular tool amongst trainees for performance of nerve blocks. This review article specifically discusses the role of ultrasonography for deeply situated nerves or plexuses such as the infraclavicular block for the upper extremity and lumbar plexus and sciatic nerve blocks for the lower extremity. Transitioning from nerve stimulation to ultrasound-guided blocks alone or in combination is beneficial in certain scenarios. However, not every patient undergoing regional anesthesia technique benefits from the use of ultrasound, especially when circumstances resulting in difficult visualization such as deep nerve blocks and/or block performed by inexperienced ultrasonographers. The use of ultrasound does not replace experience and knowledge of relevant anatomy, especially for visualization of deep structures. In certain scenarios, ultrasound may not offer additional value and substantial amount of time may be spent trying to find relevant structures or even provide a false sense of security, especially to an inexperienced operator. We look at available literature on the role of ultrasound for the performance of deep peripheral nerve blocks and its benefits.
Anatomy–ultrasound correlation for selected peripheral nerve blocks
Techniques in Regional Anesthesia and Pain Management, 2008
The practice of ultrasound guide blocks requires the development of new abilities, including the ability to recognize nerves and other structures from an ultrasound image. This ability depends on knowledge of cross-section anatomy, which is very different from the customary longitudinal anatomy. In this work, we present a correlation of anatomical and ultrasound cross-sections for select nerve blocks.
Ultrasound-guided peripheral nerve blocks of the upper limb
BJA Education, 2015
• Peripheral nerve blocks offer many potential advantages over opioid-based anaesthesia and analgesia for upper limb surgery. • The peripheral nerves of the upper limb are superficial and identified by a linear, high-frequency ultrasound transducer. Ultrasound-guided peripheral nerve blocks of the upper limb Patient selection Successful regional anaesthesia for upper limb surgery is reliant on appropriate patient selection. PNBs are advantageous in patients undergoing extensive surgery and those prone to PONV, at risk of postoperative respiratory depression or intolerant of opioids. Primary patient exclusions are patient refusal, infection
Ultrasound-Guided Posterior Femoral Cutaneous Nerve Block: A Cadaveric Study
Journal of Ultrasound in Medicine, 2017
Objectives-To identify any anatomic barriers to local anesthetic spread between the sciatic nerve (SN) and the posterior femoral cutaneous nerve (PFCN) at the level of the infragluteal crease and to describe a potential technique for an ultrasound (US)-guided subgluteal PFCN block in a cadaveric model. Methods-Bilateral US-guided subgluteal injections of a colored latex solution were performed around the SN (15 mL) and PFCN (10 mL) in 4 unembalmed cadavers, for a total of 8 cadaver thighs. The specimens were dissected after latex polymerization to observe the spread of the latex solutions. Results-With US guidance, the PFCN was visualized deep to the gluteus maximus and slightly superficial or lateral to the SN at the level of the infragluteal crease. The SN and PFCN were found on dissection to be coated with their respective colored latex in all 8 thighs. The SN and PFCN were consistently separated by the deep investing muscular fascia of the thigh, with only 2 thighs showing substantial mixing of latex injectates. Conclusions-The deep investing muscular fascia of the thigh appears to impede the spread of injectate between the SN and PFCN in a most unembalmed cadaver specimens. A US-guided subgluteal PFCN blockade may be a feasible technique to complement an SN block when complete anesthesia of the posterior thigh is required.
Ultrasound-guided sciatic nerve block: description of a new approach at the subgluteal space
British Journal of Anaesthesia, 2007
Sciatic nerve block is frequently used for anaesthesia or analgesia during orthopaedic foot surgery and there are several different approaches to the sciatic nerve. This report describes a new approach to the sciatic nerve using ultrasound. Local anesthetic was injected into the 'subgluteal space' under ultrasound guidance which was effective in producing sciatic nerve block in a small series of five patients. The anatomy, sonographic features, technique of identifying the subgluteal space, and potential advantages of this approach to the sciatic nerve are discussed.
British journal of anaesthesia, 2015
Clear visibility of the needle and catheter tip is desirable to perform safe and successful ultrasound-guided peripheral nerve blocks. This can be challenging with deeper blocks in obese patients. This study compared the visibility of echogenic and non-echogenic block needles and catheters in proximal sciatic blocks when performed with a low-frequency curved probe. Seventy-eight patients undergoing total knee joint arthroplasty were randomized to receive an ultrasound-guided continuous sciatic nerve block using either a non-echogenic needle and stimulating catheter or an echogenic needle and echogenic non-stimulating catheter. Block needles in both groups were placed using both neurostimulation and ultrasound guidance, after which the catheter was positioned using either neurostimulation alone (Stimulating group) or imaging alone (Echogenic group). Three anaesthetists blinded to group allocation graded video clips recorded during the blocks for nerve, needle and catheter visibility....
Journal of Ultrasound in Medicine
Objectives-The purpose of this study was to perform an updated analysis of complications associated with upper and lower extremity peripheral nerve blocks (PNBs) performed with ultrasound (US) guidance versus the landmark approach. Methods-We conducted a single-center retrospective cohort analysis to compare the incidence of PNB complications between the techniques. The primary outcome was local anesthetic systemic toxicity (LAST), whereas the secondary outcomes included short-and long-term nerve injuries. The current query included cases performed between 2012 and 2015. A combined analysis included data extending to 2006. The Statistical examination relied on the v 2 test. Results-During this 4-year period, we performed 7789 US-guided and 498 landmark-guided blocks with no statistically significant difference in the incidence of nerve injury or LAST between the groups. Our 10-year analysis, however, revealed a significant increase (P < .01) in the rate of LAST with the landmark technique: 7 of 5932 versus 0 of 16,858 cases. The combined data also revealed a significant increase (P < .01) in short-term injuries associated with the landmark approach (30 of 5932 versus 33 of 16,858) but no significant difference in the incidence of long-term injuries. Conclusions-Our analysis supports a conclusion that the use of US guidance during PNBs leads to a significant reduction in the incidence of LAST, adding to growing evidence from similar investigations. The impact of US on the incidence of nerve injuries remains unclear, considering that the nature of transient deficits is thought to be multifactorial, and the frequency of lasting injuries did not differ significantly in this study. Key Words-local anesthetic systemic toxicity; peripheral nerve; peripheral nerve block complications; peripheral nerve block safety; ultrasound-guided regional anesthesia; ultrasound techniques/physics A fter it was introduced in 2003, the use of ultrasound (US) for peripheral nerve blocks (PNBs) spread rapidly in North America. 1 Visualization of anatomy and needle placement at the bedside held great promise for anesthesiologists who provide PNBs as part of perioperative management. A number of randomized
Ultrasound Guided Posterior Femoral Cutaneous Nerve Block
Ağrı - The Journal of The Turkish Society of Algology, 2014
Ultrason kılavuzluğunda posterior femoral kutanöz sinir bloğu Özet Posterior femoral kutanöz sinir (PFCN) sakral pleksusun bir dalıdır. Uygun olgularda anestezi amacıyla veya turnike gerektiren cerrahilerde tamamlayıcı bir blok olarak yapılması gerekebilmektedir. Ultrasonun rejyonal anestezi pratiğine girmesiyle ve sonoanotominin daha iyi anlaşılmasıyla birlikte, anestezi uygulamalarımızda hedefe yönelik blok konseptini PFCN bloğu içinde düşünmeliyiz.