Basic Principles of Ultrasound Guided Nerve Block

This chapter provides a clinical description of ultrasound physics tailored to provide the practitioner a solid background for optimal imaging and needle guidance technique during regional anesthesia. Important ultrasound characteristics are covered, including optimization of ultrasound images, transducer selection, and features found on most point-of-care systems. In-plane and out-of-plane needle guidance techniques and a three-step process for visualizing in-plane needle insertions are presented. Next, common artifacts and errors including attenuation, dropout, and intraneural injection are covered, along with clinical solutions to overcome these inaccuracies. Preparation details are reviewed to make the regional anesthesia procedures as reproducible and safe as possible. Also included are a practical review of peripheral nerve block catheter placement principles, an appendix listing what blocks may be used for what surgeries, and seven Keys to Ultrasound Success that can make ultrasound guided regional anesthesia understandable and clinically feasible for all practitioners.