USGRA What is - Ultrasound Guided Regional Anaesthesia Web

29 Pages·2006·1.18 MB·English

Ultrasound Guided Regional Anaesthesia:
What is The Evidence?
Dr. PT CHUI
Department of Anaesthesia and Intensive Care
The Chinese University of Hong Kong
Shatin
Hong Kong
June 2006
CUHK-PWH
Regional Anaesthesia: Hurdles
(cid:56) procedure time
(cid:56) onset time
(cid:56) failure rates
(cid:56) complications
Oldman M, et al. A survey of orthopedic surgeons’ attitudes and
knowledge regarding regional anesthesia. Anesth Analg 2004;
98:1486 –90.
CUHK-PWH
Ultrasound Guided Regional Anaesthesia
the clinical use of ultrasound is four-dimensional…
A series of two-dimensional images produce a
three-dimensional map of the area. … the
operator can then direct the needle towards the
target nerve. The fourth dimension of time allows
the operator to assess the spread of local
anaesthetic during injection.
Denny NM, et al. Location, location, location! Ultrasound imaging in
regional anaesthesia. Br J Anaesth 2005; 94: 1–3.
CUHK-PWH
Ultrasound: advantages
(cid:190) assessment of normal anatomy
(cid:57) in vivo systematic examination enhances anatomic
understanding
(cid:57) supplement to anatomy textbooks, cadaver
dissections, and MRI studies
(cid:190) difficult, variant, and abnormal anatomy
(cid:57) modified approach to improve success and avoid
complications
Greher M. Is regional anesthesia simply an exercise in applied
sonoanatomy? Anesthesiology 2003; 99:250–1.
CUHK-PWH
Ultrasound: advantages
(cid:190) real-time guidance of needle puncture,
navigation and injection
(cid:57) direct visualization of needle and needle tip
(cid:57) identification of adjacent structures to avoid injuries
(cid:57) observation of needle-nerve interaction and local
anesthetic spread
Greher M. Is regional anesthesia simply an exercise in applied
Sonoanatomy? Anesthesiology 2003; 99:250–1.
CUHK-PWH
What is the evidence?
Is ultrasound guided regional anaesthesia
easier, faster, safer, and more effective?
CUHK-PWH
Ultrasound Guided Regional Anaesthesia
Ramdomized Controlled Double-Blind Studies are
NOT feasible for US Guided Regional Anaesthesia
Randomized Controlled Studies
xx
Case Series
Technical Feasibility Studies
CUHK-PWH
Evidence: Case Studies
Technical Feasibility Reports
Marhofer P, et al. New perspectives in regional anesthesia: the use of ultrasound –
past, present, and future. Can J Anesth 2005; 52(6):R1-6.
CUHK-PWH
Evidence: Case Series
Infraclavicular Block
(cid:190) 60 patients
(cid:190) injections (15 ml x2) medial and lateral to
subclavian artery: “doughnut sign”
(cid:57) 57 (95%) patients without supplements
(cid:57) subclavian a. and v., pleura, lung identified
(cid:57) 3 patients: paresthesia
(cid:57) no other complications
Ootaki C, et al. Ultrasound-guided infraclavicular brachial plexus block:
an alternative technique to anatomical landmark-guided approaches.
Reg Anesth Pain Med 2002;25:600-4.
CUHK-PWH
Evidence: Case Series
Infraclavicular Block
(cid:190) 126 patients
(cid:190) injection around each cord (total x3), with test injectate
(1-2 ml) to assess spread
(cid:57) time to perform block 10 (4.4) min
(cid:57) complete block 6.7 (3.2) min
(cid:57) 114 (90%) patients without GA or supplementation
(cid:57) 53 patients: catheter for continuous block
(cid:57) complications
• 1 patient: blood aspirated from needle
• 3 patients: paresthesia
Sandhu NS, et al. Ultrasound-guided infraclavicular brachial plexus
block. Br J Anaesth. 2002; 89:254-259.