scholarly journals Accuracy of Ultrasound-guided Nerve Blocks of the Cervical Zygapophysial Joints

2012 ◽  
Vol 117 (2) ◽  
pp. 347-352 ◽  
Author(s):  
Andreas Siegenthaler ◽  
Sabine Mlekusch ◽  
Sven Trelle ◽  
Juerg Schliessbach ◽  
Michele Curatolo ◽  
...  
Keyword(s):  
Ultrasound Imaging ◽  
Ultrasound Guidance ◽  
Good Accuracy ◽  
Medial Branch ◽  
Needle Placement ◽  
Needle Guidance ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Zygapophysial Joint ◽  
Fluoroscopic Imaging

Background Cervical zygapophysial joint nerve blocks typically are performed with fluoroscopic needle guidance. Descriptions of ultrasound-guided block of these nerves are available, but only one small study compared ultrasound with fluoroscopy, and only for the third occipital nerve. To evaluate the potential usefulness of ultrasound-guidance in clinical practice, studies that determine the accuracy of this technique using a validated control are essential. The aim of this study was to determine the accuracy of ultrasound-guided nerve blocks of the cervical zygapophysial joints using fluoroscopy as control. Methods Sixty volunteers were studied. Ultrasound-imaging was used to place the needle to the bony target of cervical zygapophysial joint nerve blocks. The levels of needle placement were determined randomly (three levels per volunteer). After ultrasound-guided needle placement and application of 0.2 ml contrast dye, fluoroscopic imaging was performed for later evaluation by a blinded pain physician and considered as gold standard. Raw agreement, chance-corrected agreement κ, and chance-independent agreement Φ between the ultrasound-guided placement and the assessment using fluoroscopy were calculated to quantify accuracy. Results One hundred eighty needles were placed in 60 volunteers. Raw agreement was 87% (95% CI 81-91%), κ was 0.74 (0.64-0.83), and Φ 0.99 (0.99-0.99). Accuracy varied significantly between the different cervical nerves: it was low for the C7 medial branch, whereas all other levels showed very good accuracy. Conclusions Ultrasound-imaging is an accurate technique for performing cervical zygapophysial joint nerve blocks in volunteers, except for the medial branch blocks of C7.

Regional anaesthesia of the upper limb

2017 ◽  
Author(s):  
Colin J. L. McCartney ◽  
Alan J. R. Macfarlane
Keyword(s):  
Peripheral Nerve ◽  
Upper Limb ◽  
Regional Anaesthesia ◽  
Ultrasound Guidance ◽  
Nerve Supply ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Traditional Approaches ◽  
Indications And Complications

Peripheral nerve blocks of the upper limb can provide excellent anaesthesia and postoperative analgesia. A variety of well-established traditional approaches to the brachial plexus exist, namely interscalene, supraclavicular, infraclavicular, and axillary techniques. Individual terminal nerves such as the median, radial, ulnar, and other smaller nerves can also be blocked more distally. The traditional and ultrasound-guided approach to each of these nerve blocks is discussed in turn in this chapter, along with specific indications and complications. The introduction of ultrasound guidance has generated significant excitement in this field in the last 10 years and has been demonstrated to improve efficacy and reduce complications. However, a sound knowledge of anatomy of the nerve supply to the upper limb remains essential during any upper limb regional anaesthesia technique.

Poster 267: The Incidence of Intravascular Needle Placement While Performing Medial Branch Nerve Blocks in the Lumbar Spine

2008 ◽  
Vol 89 (11) ◽  
pp. e106
Author(s):  
Benjamin R. Humpherys ◽  
Jonathon C. Komar ◽  
Anthony A. Lee ◽  
Michael J. Simek ◽  
Michael W. Wolff
Keyword(s):  
Lumbar Spine ◽  
Medial Branch ◽  
Needle Placement ◽  
Nerve Blocks

scholarly journals Ultrasound-Guided Trigger Point Injections in the Cervicothoracic Musculature: A New and Unreported Technique

2008 ◽  
Vol 6;11 (12;6) ◽  
pp. 885-889 ◽  
Author(s):  
Kenneth P. Botwin
Keyword(s):  
Ultrasound Guidance ◽  
Myofascial Pain ◽  
Trigger Point ◽  
Trigger Points ◽  
Target Tissue ◽  
Obese Patients ◽  
Needle Placement ◽  
Ultrasound Guided ◽  
Myofascial Trigger Points ◽  
Point Injection

Background: Myofascial pain is defined as pain that originates from myofascial trigger points in skeletal muscle. It is prevalent in regional musculoskeletal pain syndromes, either alone or in combination with other pain generators. The myofascial pain syndrome is one of the largest groups of under diagnosed and under treated medical problems encountered in clinical practice. Trigger points are commonly seen in patients with myofascial pain which is responsible for localized pain in the affected muscles as well as referred pain patterns. Correct needle placement in a myofascial trigger point is vital to prevent complications and improve efficacy of the trigger point injection to help reduce or relieve myofascial pain. In obese patients, these injections may not reach the target tissue. In the cervicothoracic spine, a misguided or misplaced injection can result in a pneumothorax. Here, we describe an ultrasound-guided trigger point injection technique to avoid this potential pitfall. Office based ultrasound-guided injection techniques for musculoskeletal disorders have been described in the literature with regard to tendon, bursa, cystic, and joint pathologies. For the interventionalist, utilizing ultrasound yields multiple advantages technically and practically, including observation of needle placement in real-time, ability to perform dynamic studies, the possibility of diagnosing musculoskeletal pathologies, avoidance of radiation exposure, reduced overall cost, and portability of equipment within the office setting. To our knowledge, the use of ultrasound guidance in performing trigger point injection in the cervicothoracic area, particularly in obese patients, has not been previously reported. Methods: A palpable trigger point in the cervicothoracic musculature was localized and marked by indenting the skin with the tip of a plastic needle cover. The skin was then sterile prepped. Then, using an ultrasound machine with sterile coupling gel and a sterile latex free transducer cover, the musculature in the cervicothoracic spine where the palpable trigger point was detected was visualized. Then utilizing direct live ultrasound guidance, a 25-gauge 1.5 inch needle connected to a 3 mL syringe was placed into the muscle at the exact location of the presumed trigger point. This guidance helps confirm needle placement in muscle tissue and not in an adipose tissue or any other non-musculature structure. Results: The technique is simple to be performed by a pain management specialist who has ultrasound system training. Conclusion: Ultrasound-guided trigger point injections may help confirm proper needle placement within the cervicothoracic musculature. The use of ultrasound-guided trigger point injections in the cervicothoracic musculature may also reduce the potential for a pneumothorax by an improperly placed injection. Key words: Trigger point injection, myofascial pain, ultrasound

T711 CERVICAL FACET JOINT NERVE BLOCKS, A NOVEL TECHNIQUE BASED ON ULTRASOUND GUIDED NEEDLE PLACEMENT

2011 ◽  
Vol 5 (S1) ◽  
pp. 98-98
Author(s):  
A. Siegenthaler ◽  
S. Mlekusch ◽  
J. Schliessbach ◽  
M. Curatolo ◽  
U. Eichenberger
Keyword(s):  
Facet Joint ◽  
Needle Placement ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Novel Technique ◽  
Cervical Facet ◽  
Cervical Facet Joint

scholarly journals A Survey on Teaching Ultrasound-Guided Chronic Pain Procedures in Pain Medicine Fellowship Programs

2014 ◽  
Vol 6;17 (6;12) ◽  
pp. E681-E689
Author(s):  
Bassem O. Asaad
Keyword(s):  
Chronic Pain ◽  
Ultrasound Guidance ◽  
Response Rate ◽  
Program Directors ◽  
Fellowship Training ◽  
Pain Medicine ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Fellowship Programs ◽  
Ultrasound Technology

Background: Over the last decade ultrasound guidance (USG) has been utilized very successfully in acute pain procedures to confirm nerves’ anatomic location and obtain live images. Not only the utilization, but the teaching, of USG has become an essential part of anesthesiology residency training. Prior to the introduction of USG, chronic pain procedures were always done either under fluoroscopy or blindly. USG offers advantages over fluoroscopy for completion of chronic pain procedures. USG decreases radiation exposure and the expenses associated with operating a fluoroscopy machine and allows live visualization of soft tissues and blood flow, a feature that fluoroscopy does not directly offer. Even today, the utilization and teaching of the technique for chronic pain procedures has not been as widely accepted as in acute pain management. Objectives: To understand the current practices and the factors affecting the teaching of ultrasound guided chronic pain procedures in chronic pain fellowship programs throughout the United States. Study Design: Survey conducted by internet and mail. The survey was distributed to program directors of ACGME-accredited pain medicine fellowships. When the survey was distributed there were 92 accredited pain medicine fellowships. Methods: REDCap survey software was used for designing the questionnaire and sending email invitations. Also, paper questionnaires were sent to those who did not respond electronically. Additional copies of the survey were mailed or faxed upon request. We received 43 responses (a response rate of 46.7%). Statistical analyses included frequencies, crosstabs, and nonparametric Spearman rank-order correlations. Results: The majority of stellate ganglion blocks, occipital nerve blocks, and peripheral nerve blocks are currently being done under ultrasound guidance. Although interest among trainees is very high, only 48.8% of the fellowship programs require fellows to learn the technique before graduation and 32.6% of the program directors agree that teaching of USG should be an ACGME requirement for pain medicine fellowship training. Faculty training is considered to be the most important factor for teaching the technique by 62.8% of directors. In the opinion of the majority of program directors, the greatest factor that stands against teaching the technique is the fact that it is time consuming. Nearly half (44.2%) of program directors believe that the technique will never replace fluoroscopy; but one quarter (25.6%) think that the new 3D ultrasound technology, when available, will replace fluoroscopy. Limitations: A moderate response rate (46.7%) may limit the generalizability of the findings. However, our survey respondents seem to represent the study population quite well, although there was a bias towards the university-based programs. Training programs located at community-based hospitals and U.S. government installations were not as well represented. Conclusion: The teaching of ultrasound guided chronic pain procedures varies significantly between individual programs. Though many program directors do require that fellows demonstrate competency in the technique before graduation, as of today there is no ACGME guideline regarding this. The advancement in ultrasound technology and the increase in number of trained faculty may significantly impact the use of USG in training fellows to perform chronic pain procedures. Key words: Ultrasound guidance, fluoroscopy, chronic pain procedures, regional nerve blocks, musculoskeletal procedures, implantable devices, pain medicine, fellowship training, anesthesia residency training

scholarly journals Ultrasound-guided spinal stereotactic system for intraspinal implants

2018 ◽  
Vol 29 (3) ◽  
pp. 292-305 ◽  
Author(s):  
Amirali Toossi ◽  
Dirk G. Everaert ◽  
Peter Seres ◽  
Jacob L. Jaremko ◽  
Kevin Robinson ◽  
...  
Keyword(s):  
Spinal Cord ◽  
White Matter ◽  
Ultrasound Imaging ◽  
Gray Matter ◽  
Ultrasound Guidance ◽  
Intraoperative Ultrasound ◽  
Alignment Error ◽  
Ultrasound Guided ◽  
Stereotactic System ◽  
Intraoperative Ultrasound Imaging

OBJECTIVEThe overall goal of this study was to develop an image-guided spinal stereotactic setup for intraoperative intraspinal microstimulation (ISMS). System requirements were as follows: 1) ability to place implants in various segments of the spinal cord, targeting the gray matter with a < 0.5-mm error; 2) modularity; and 3) compatibility with standard surgical tools.METHODSA spine-mounted stereotactic system was developed, optimized, and tested in pigs. The system consists of a platform supporting a micromanipulator with 6 degrees of freedom. It is modular and flexible in design and can be applied to various regions of the spine. An intraoperative ultrasound imaging technique was also developed and assessed for guidance of electrode alignment prior to and after electrode insertion into the spinal cord. Performance of the ultrasound-guided stereotactic system was assessed both in pigs (1 live and 6 fresh cadaveric pigs) and on the bench using four gelatin-based surrogate spinal cords. Pig experiments were conducted to evaluate the performance of ultrasound imaging in aligning the electrode trajectory using three techniques and under two conditions. Benchtop experiments were performed to assess the performance of ultrasound-guided targeting more directly. These experiments were used to quantify the accuracy of electrode alignment as well as assess the accuracy of the implantation depth and the error in spatial targeting within the gray matter of the spinal cord. As proof of concept, an intraoperative ISMS experiment was also conducted in an additional live pig using the stereotactic system, and the resulting movements and electromyographic responses were recorded.RESULTSThe stereotactic system was quick to set up (< 10 minutes) and provided sufficient stability and range of motion to reach the ISMS targets reliably in the pigs. Transverse ultrasound images with the probe angled at 25°–45° provided acceptable contrast between the gray and white matter of the spinal cord. In pigs, the largest electrode alignment error using ultrasound guidance, relative to the minor axis of the spinal cord, was ≤ 3.57° (upper bound of the 95% confidence interval). The targeting error with ultrasound guidance in bench testing for targets 4 mm deep into the surrogate spinal cords was 0.2 ± 0.02 mm (mean ± standard deviation).CONCLUSIONSThe authors developed and evaluated an ultrasound-guided spinal stereotactic system for precise insertion of intraspinal implants. The system is compatible with existing spinal instrumentation. Intraoperative ultrasound imaging of the spinal cord aids in alignment of the implants before insertion and provides feedback during and after implantation. The ability of ultrasound imaging to distinguish between spinal cord gray and white matter also improves confidence in the localization of targets within the gray matter. This system would be suitable for accurate guidance of intraspinal electrodes and drug or cell injections.

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.

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