Ultrasound and Regional Anesthesia Technique: Are There Really Ultrasound Guidance Technical Limits in Sciatic Nerve Blocks?

2008 ◽  
Vol 33 (3) ◽  
pp. 281-282 ◽  
Author(s):  
G DANELLI ◽  
D GHISI ◽  
A ORTU
Keyword(s):  
Sciatic Nerve ◽  
Regional Anesthesia ◽  
Ultrasound Guidance ◽  
Nerve Blocks ◽  
Anesthesia Technique

scholarly journals Subparaneural injection in popliteal sciatic nerve blocks evaluated by MRI

Open Medicine ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. 346-353
Author(s):  
Benedikt Büttner ◽  
Alexander Schwarz ◽  
Caspar Mewes ◽  
Katalin Kristof ◽  
José Hinz ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Local Anesthetic ◽  
Ultrasound Guidance ◽  
Resonance Imaging ◽  
Nerve Blocks ◽  
Cross Sectional ◽  
Neurological Sequelae ◽  
Patient Reported ◽  
Study Population ◽  
Intraneural Injection

AbstractIntraneural injection of a local anesthetic can damage the nerve, yet it occurs frequently during distal sciatic block with no neurological sequelae. This has led to a controversy about the optimal needle tip placement that results from the particular anatomy of the sciatic nerve with its paraneural sheath.The study population included patients undergoing lower extremity surgery under popliteal sciatic nerve block. Ultrasound-guidance was used to position the needle tip subparaneurally and to monitor the injection of the local anesthetic. Sonography and magnetic resonance imaging were used to assess the extent of the subparaneural injection.Twenty-two patients participated. The median sciatic cross-sectional area increased from 57.8 mm2 pre-block to 110.8 mm2 immediately post-block. An intraneural injection according to the current definition was seen in 21 patients. Two patients had sonographic evidence of an intrafascicular injection, which was confirmed by MRI in one patient (the other patient refused further examinations). No patient reported any neurological symptoms.A subparaneural injection in the popliteal segment of the distal sciatic nerve is actually rarely intraneural, i.e. intrafascicular. This may explain the discrepancy between the conventional sonographic evidence of an intraneural injection and the lack of neurological sequelae.

scholarly journals Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Anupama Wadhwa ◽  
Sunitha Kanchi Kandadai ◽  
Sujittra Tongpresert ◽  
Detlef Obal ◽  
Ralf Erich Gebhard
Keyword(s):  
Peripheral Nerve ◽  
Regional Anesthesia ◽  
Nerve Stimulation ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Sense Of Security ◽  
False Sense ◽  
Anesthesia Technique ◽  
Additional Value

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.

scholarly journals A Survey of Regional Anesthesia Use In Greece And The Impact of A Structured Regional Anesthesia Course On Regional Techniques Knowledge And Practice

2021 ◽  
Author(s):  
Kassiani Theodoraki ◽  
Eleni Moka ◽  
Alexandros Makris ◽  
Evmorfia Stavropoulou
Keyword(s):  
Regional Anesthesia ◽  
Ultrasound Guidance ◽  
Electronic Database ◽  
Nerve Blocks ◽  
Training Course ◽  
Hands On ◽  
Lower Limb Surgery ◽  
Knowledge And Attitude ◽  
Ra Training ◽  
The Impact

Abstract Background: Due to the growing interest in regional anesthesia (RA) techniques and the realization of the need for formalized education in them, the Greek Chapter of the European Society of Regional Anesthesia and Pain Therapy (ESRA-Hellas) has established a structured hands-on training Course held annually since 2009, which is quite popular in the community of Greek anesthesiologists. The aim of the current survey was two-fold: first to provide an overview about the current practice of RA in Greece and secondly to evaluate the effect the aforementioned training Course has on participants’ knowledge and attitude towards RA.Methods: An electronic questionnaire was uploaded on SurveyMonkey and a link giving access to the questionnaire was forwarded via email to an electronic database of 825 practicing Greek anesthesiologists held in the electronic database of ESRA Hellas. The survey was totally anonymous and no identifying information was collected throughout. It contained questions relating to the anesthesiologists’ demographic characteristics, their RA practice and information pertaining to the RA training Course.Results: A total of 424 fully completed questionnaires were received, representing an overall response rate of 51.4%. Attendants of the Course are more familiar with the performance of peripheral nerve blocks with neurostimulation and/or ultrasound guidance as compared to non-attendants (p<0.001). Attendants are also less likely to practice exclusively general anesthesia, more likely to use peripheral blocks for lower limb surgery and more likely to consider taking the European Diploma of RA in comparison to non-attendants (p<0.001, p=0.018 and p=0,002, respectively). Both cohorts consider the Course of value and agree that the main reason to use regional techniques is to ensure optimal postoperative analgesia while the main hindrance to RA practice is the lack of relevant education in the techniques, especially those under ultrasound guidance. Regarding improvement of the Course, most participants suggested devoting ampler time in ultrasound hands-on practice and application.Conclusion: Greek anesthesiologists seek educational activities in the field of RA and the Course seems to fulfil the majority of attendants’ expectations. There will be further effort by the organizers to improve weaknesses of the current Course and undertake further educational initiatives in the field of RA according to international recommendations.

scholarly journals Ultrasound guidance showing real-time local anesthetic extravasation during injection of two lateral popliteal sciatic nerve blocks

2013 ◽  
Vol 3 (4) ◽  
Author(s):  
Andres Missair ◽  
Brian Osman ◽  
Robyn S. Weisman ◽  
Catalina Castillo-Pedraza ◽  
Ralf E. Gebhard
Keyword(s):  
Sciatic Nerve ◽  
Real Time ◽  
Local Anesthetic ◽  
Ultrasound Guidance ◽  
Nerve Blocks

Refining the rat sciatic nerve block: a novel ultrasound-guided technique

2021 ◽  
pp. 002367722110346
Author(s):  
Scott Hughey ◽  
Donald Campbell ◽  
Kamala Rapp-Santos ◽  
Jacob Cole ◽  
Gregory Booth ◽  
...  
Keyword(s):  
Sciatic Nerve ◽  
Nerve Block ◽  
Ultrasound Guidance ◽  
Sciatic Nerve Block ◽  
Sprague Dawley ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Translational Studies ◽  
Translational Models ◽  
Nerve Staining

Murine translational models are an important tool to understand pain pathophysiology. One procedure used frequently in murine research is the sciatic nerve block. This study sought to demonstrate the use of ultrasound-guided sciatic nerve block in a cadaveric murine model. A total of 40 injections were performed in 20 Sprague–Dawley male 18-month-old rat cadavers. Necropsy was performed to identify staining of the sciatic nerve. Staining with methylene blue occurred in 40 of 40 ultrasound-guided injections. The extremely accurate nature of this block under ultrasound guidance is favorable for future translational studies in rats undergoing sciatic nerve blocks. This method may represent a significant improvement in current methods.

scholarly journals Lower extremity regional anesthesia: essentials of our current understanding

2019 ◽  
Vol 44 (2) ◽  
pp. 143-180 ◽  
Author(s):  
De Q Tran ◽  
Francis V Salinas ◽  
Honorio T Benzon ◽  
Joseph M Neal
Keyword(s):  
Lower Extremity ◽  
Regional Anesthesia ◽  
Lower Limb ◽  
Ultrasound Guidance ◽  
Evidence Based ◽  
Nerve Blocks ◽  
Pharmacological Agents ◽  
Current Review ◽  
American Society ◽  
Selection Of

The advent of ultrasound guidance has led to a renewed interest in regional anesthesia of the lower limb. In keeping with the American Society of Regional Anesthesia and Pain Medicine’s ongoing commitment to provide intensive evidence-based education, this article presents a complete update of the 2005 comprehensive review on lower extremity peripheral nerve blocks. The current review article strives to (1) summarize the pertinent anatomy of the lumbar and sacral plexuses, (2) discuss the optimal approaches and techniques for lower limb regional anesthesia, (3) present evidence to guide the selection of pharmacological agents and adjuvants, (4) describe potential complications associated with lower extremity nerve blocks, and (5) identify informational gaps pertaining to outcomes, which warrant further investigation.

Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities

2021 ◽  
Vol 25 (2) ◽  
Author(s):  
Mehmet Sahap ◽  
Handan Gulec ◽  
Abdulkadir But ◽  
Selcuk Gulec ◽  
Ayca Dumanlı Ozcan
Keyword(s):  
Spinal Anesthesia ◽  
Multiple Trauma ◽  
Regional Anesthesia ◽  
Advanced Age ◽  
Nerve Blocks ◽  
Aged Patients ◽  
Respiratory Problems ◽  
Anesthesia Management ◽  
Anesthesia Technique ◽  
Selection Of

The higher incidence of comorbidities in advanced age causes difficulties in anesthesia management. When choosing the anesthesia technique in old aged patients, our target must be to avoid aggravating the existing systemic diseases and avoid disturbing the hemodynamics to ensure their rapid return to routine life.  In this case report, we present our choice of infraclavicular nerve block accompanied with spinal anesthesia in a patient with advanced age and several comorbidities, who sustained multiple trauma. The surgery of the patient was successfully performed with minimal effects on the hemodynamics, and he was transferred to the clinic. We stress careful selection of the most appropriate anesthesia technique according to the existing state of the patient, and opting for appropriate nerve blocks even to the patients with respiratory problems. Key words: Advanced age; Trauma; Spinal anesthesia; Infraclavicular block Citation: Sahap M, Gulec H, But A, Gulec S, Ozcan AD. Regional anesthesia in a patient with multiple trauma, advanced age and multiple comorbidities. Anaesth. pain intensive care 2021;25(2):222-224. DOI: 10.35975/apic.v25i2.1475 Received: 1 December 2020, Reviewed: 7 February 2021, Accepted: 23 February 2021

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