Ultrasound guidance in regional anaesthesia and interventional pain management
Authors:
Michálek Pavel 1; Mach Dušan 2; Pokorný Lukáš 1; Gabrhelík Tomáš 3
Authors‘ workplace:
Department of Anaesthetics, Antrim Area Hospital, Antrim, United Kingdom
1; Department of Anaesthesia, Royal Victoria Hospital, Belfast, United Kingdom
2; Klinika anesteziologie a resuscitace, FN Olomouc, Česká republika
3
Published in:
Anest. intenziv. Med., 21, 2010, č. 1, s. 7-13
Category:
Anesthesiology - Review Article
Overview
The use of ultrasound guidance for regional anaesthesia and interventional pain management marked the start of a new era at the end of the last century. New portable ultrasound machines with high-frequency probes allow visualisation of even very small nerve structures. Ultrasound-guided blocks offer some potential advantages when compared with other techniques such as neurostimulation or anatomical landmarks: a precise, real-time location of the needle-nerve relationship, an evaluation of the local anaesthetic distribution and a decreased risk of inadvertent vascular puncture. In some blocks, ultrasound guidance has helped to decrease the amount of local anaesthetic, improve the quality of the block or speed up the onset of regional anaesthesia. Ultrasound guidance may be used not only for brachial plexus blockades and lower extremity regional techniques, but also with lower frequency probes for neuraxial blocks such as epidurals, subarachnoid blocks and paravertebral blocks. Other techniques in which ultrasound guidance may be of use include blocks of the fascial and muscular compartments – the rectus sheath block, transversus abdominis plane block and fascia iliaca block in the setting of postoperative pain management. Ultrasound guidance may also be helpful in some techniques used for chronic pain management. Catheters to the peripheral nerves as well as some sympathetic nerve blocks including stellate ganglion and coeliac plexus may be performed under ultrasound. Endosonography combines the principles of endoscopy and ultrasound and can be used for the transgastric block of the celiac plexus or blockade of the superior hypogastric plexus through the urinary bladder.
Keywords:
ultrasound guidance – plexus blocks – neuraxial blocks – pain treatment
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