Ultrasound Guidance in Regional Anaesthesia: Principles and practical implementation

261 Pages·2010·6.55 MB·English

by  Peter Marhofer

Ultrasound Guidance in
Regional Anaesthesia
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Ultrasound
Guidance in
Regional
Anaesthesia
Principles and Practical
Implementation
SECOND EDITION
Peter Marhofer, MD
Professor of Anaesthesia and Intensive Care Medicine
Department of Anaesthesia, Intensive Care Medicine and
Pain Therapy,
Medical University of Vienna,
Vienna, Austria

1
1
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First edition published as Ultrasound Guidance for Nerve Blocks, 2008
Second edition published 2010
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Dedicated to my parents who supported me always
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Contents
Acknowledgements x i
Foreword by Professor Admir Hadzic x iii
Foreword by Professor Narinder Rawal x v
Foreword: The surgeon’s view by Professor Christian Fialka xvii
Contributors xix
How to use this book x xi
Abbreviations x xiii
1 Basic principles of ultrasonography 1
1.1 Nature of sound waves 1
1.2 Piezoelectric effect 2
1.3 Pulse-echo instrumentation 2
1.4 Resolution and electronic focusing 4
1.5 Time-gain compensation 6
1.6 Measuring velocity with pulsed ultrasound 8
1.7 Ultrasound imaging modes 9
1.8 Common image artefacts 14
1.9 Needle visualization 16
1.10 Equipment needed for ultrasound imaging 18
2 The scientific background of ultrasound guidance in regional
anaesthesia 2 1
3 Initial considerations and potential advantages of regional
anaesthesia under ultrasound guidance 2 3
3.1 History of ultrasound-guided regional anaesthesia 2 3
3.2 Possible advantages of ultrasound-guided regional anaesthesia 24
4 Technique limitations and suggestions for a training concept 3 3
4.1 Technical limitations 33
4.2 Non-technical limitations 3 3
4.3 Suggestions for a training concept in ultrasound-guided regional
anaesthesia 3 4
viii CONTENTS
5 Have we reached the gold standard in regional anaesthesia? 3 7
6 Technical and organization prerequisites for
ultrasonographic-guided blocks 4 1
6.1 Technical considerations 41
6.2 Organization 5 3
6.3 Post-operative observation 54
6.4 Other considerations 54
7 Ultrasound-guided regional anaesthetic techniques in children:
current developments and particular considerations 5 7
7.1 Management of minor trauma in children 5 8
8 Ultrasound appearance of nerves and other anatomical or
non-anatomical structures 63
8.1 Appearance of nerves in ultrasonography 63
8.2 Strategies when nerves are not visible 6 6
8.3 Appearance of neuronal-related structures in ultrasonography 6 7
8.4 Appearance of other anatomical structures in ultrasound 71
8.5 Appearance of artefacts in ultrasound 7 6
9 Needle guidance techniques 81
9.1 Out-of-plane (OOP) needle guidance technique 8 2
9.2 In-plane (IP) needle guidance technique 8 2
9.3 How to approach a nerve? 85
10 Pearls and pitfalls 8 7
10.1 Setting and orientation of the probe 8 7
10.2 Pressure during injection 8 7
10.3 Jelly pad for extreme superficial structures 8 8
11 Nerve supply of big joints 89
11.1 Shoulder joint 8 9
11.2 Elbow joint 8 9
11.3 Wrist 9 0
11.4 Hip joint 9 0
11.5 Knee joint 9 1
11.6 Ankle 9 1
12 Neck blocks 9 3
12.1 General anatomical considerations 9 3
12.2 Deep cervical plexus blockade 9 3
12.3 Superficial cervical plexus blockade 9 5
12.4 Implication of neck blocks in children 1 00
CONTENTS ix
13 Upper extremity blocks 101
13.1 General anatomical considerations 1 01
13.2 Interscalene brachial plexus approach 102
13.3 Supraclavicular approach 108
13.4 Infraclavicular approach 1 11
13.5 Axillary approach 114
13.6 Suprascapular nerve block 1 20
13.7 Median nerve block 1 22
13.8 Ulnar nerve block 1 25
13.9 Radial nerve block 1 28
13.10 Implications of upper limb blocks in children 130
14 Lower extremity blocks 1 33
14.1 General anatomical considerations 1 33
14.2 Psoas compartment block 1 33
14.3 Femoral nerve block 137
14.4 Saphenous nerve block 140
14.5 Lateral femoral cutaneous nerve block 1 45
14.6 Obturator nerve block 148
14.7 Sciatic nerve blocks 151
14.8 Ankle blocks 1 63
14.9 Implications of lower limb blocks in children 169
15 Truncal blocks 173
15.1 General anatomical considerations 1 73
15.2 Intercostal blocks 1 73
15.3 Ilioinguinal-iliohypogastric nerve blocks 1 76
15.4 Rectus sheath block 1 78
15.5 Transversus abdominis plane (TAP) block 183
15.6 Implications of truncal blocks in children 1 84
16 Neuraxial block techniques 1 89
16.1 General considerations 189
16.2 Epidural blocks 1 89
16.3 Paravertebral blocks 193
16.4 Implications in children 196
17 Peripheral catheter techniques 203
18 Future perspectives 205
18.1 Regional blocks for particular patient populations 205
18.2 Education 2 05
18.3 Technical developments 206