scholarly journals Let Go’ technique in ultrasound guided Regional Anaesthesia

2019 ◽  
Vol 5 (3) ◽  
Author(s):  
Shiv Kumar Singh ◽  
Tuhin Mistry
Keyword(s):  
Local Anaesthetic ◽  
Regional Anaesthesia ◽  
Current Practice ◽  
Injection Technique ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Keywords Ultrasound ◽  
Needle Technique

Background: The local anaesthetic(LA) injection technique during ultrasound guided nerve blocks varies worldwide. This online poll was conceived to explore the current practice among the anaesthesiologists. Methodology: Two separate polls were created and posted at the same time with appropriate multiple choices in a closed Facebook group ‘The Anaesthetist’. Participants were allowed to take part in these online-based polls over a period of seven days. The responses were collected and put down in the Excel sheet to calculate absolute numbers and percentages. Results: Among the respondents, 63.45% of the ultrasound users keep hold on to the needle and let a trained assistant inject the LA while 14.61 % of the responders use ‘Let Go’ of the needle technique and inject the LA themselves. Amongst 248 ultrasound users, only one anaesthesiologist use Jedi grip but no one is currently using other grips described in the literature. Conclusion: LA injection technique varies among the anaesthesiologists throughout the globe. Majority of the anaesthesiologists let a trained assistant inject the LA and some inject the LA themselves. Keywords: Ultrasound, Regional Anaesthesia, Jedi grip, Bedforth grip, On-lock grip, ‘let-go’ of the needle, Single-handed injection technique, Online poll

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.

Regional anaesthesia

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Local Anaesthetic ◽  
Lower Limb ◽  
Regional Anaesthesia ◽  
Anatomical Landmarks ◽  
Ultrasound Guided ◽  
Anaesthetic Agents

The regional anaesthesia chapter discusses the pharmacology of local anaesthetic agents, techniques of nerve localisation, practical aspects of ultrasound-guided blocks and the advantages and complications of regional anaesthesia. Common, and clinically useful, blocks for the upper and lower limb are described in detail with pictures of anatomical landmarks and ultrasound appearance to compliment the description. Indications, technique, volumes required and complications are described for each block.

scholarly journals A Novel Plant Based Ultrasound Phantom

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Shiv Kumar Singh ◽  
Tuhin Mistry
Keyword(s):  
Regional Anaesthesia ◽  
Low Cost ◽  
Aloe Vera ◽  
Needle Insertion ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Aloe Barbadensis ◽  
Animal Products ◽  
Other Substances ◽  
Ultrasound Phantom

Introduction In most of the ultrasound guided regional anaesthesia workshops, anaesthesiologists usually concentrate on identification of nerves & plexus on human volunteers and practice needling techniques on phantom. Proper needle insertion technique and correct manipulation are two important skills for ultrasound-guided peripheral nerve blocks. These skills can be sharpened by practicing on ultrasound phantom. It also helps anaesthesiologists to develop, practice and maintain the skills needed for regional anaesthesia and vascular access procedures [1]. But the use of phantoms is often limited due to the cost of the blue phantom [2]. Many courses use meat-based products like turkey legs or porcine models but these may not be acceptable to everyone [3,4]. Vegetable based models using gelatine also may not be acceptable as it too is made from animal products. We describe novel use of Aloe Vera (AV)stem as phantom for US guided needling training. This natural AV gel-based phantom can be used for scanning, needling and refine other relevant skills. The AV phantom can be constructed from low cost, readily available natural source and is reusable. Various materials have been used to make ultrasound training phantoms. Commercially available phantoms are expensive and homemade nerve block models are cumbersome to prepare [5]. The Aloe Vera gel is obtained from Aloe Vera plant (Aloe barbadensis miller). It is a natural product which has been used for centuries in various field specially in dermatology. Aloe Vera leaves are triangular and fleshy with serrated edges. Each leaf contains an inner clear gel which is made of 99% water and other substances (glucomannans, amino acids, lipids, sterols and vitamins) [6]. Aloe Vera is odorless and semi-transparent unlike meat-based models. Preparing the Aloe Vera US Model The covering of the leaves is non-echogenic and hence the pulp from Aloe Vera leaves is separated and placed in layers and covered with a Transparent Dressing(Te

scholarly journals Investigation of a New Echogenic Needle for use with Ultrasound Peripheral Nerve Blocks

2007 ◽  
Vol 35 (4) ◽  
pp. 582-586 ◽  
Author(s):  
R. K. Deam ◽  
R. Kluger ◽  
J. Barrington ◽  
C.A. McCutcheon
Keyword(s):  
Peripheral Nerve ◽  
Nerve Block ◽  
Regional Anaesthesia ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Peripheral Nerve Blocks ◽  
Ultrasonic Image

A new ‘texturing method’ has been developed for nerve block needles in an attempt to improve the ultrasonic image of the needles. Using a synthetic phantom, these textured needles were compared to currently available needles. The textured needle had improved visibility under ultrasound. This type of needle may assist the anaesthetist perform ultrasound-guided regional anaesthesia.

scholarly journals Two-Dimensional Mapping to Assess Direction and Magnitude of Needle Tip Error in Ultrasound-Guided Regional Anaesthesia

2011 ◽  
Vol 39 (6) ◽  
pp. 1076-1081 ◽  
Author(s):  
S. Hebard ◽  
G. Hocking ◽  
K. Murray
Keyword(s):  
Regional Anaesthesia ◽  
Two Dimensional ◽  
Ultrasound Guided ◽  
Nerve Blocks ◽  
Subjective Data ◽  
Control Objective ◽  
Human Cadavers ◽  
Tip Position ◽  
Needle Visibility ◽  
Dimensional Mapping

We assessed whether echogenic needles reduce tip location error, by comparing three echogenic designs (Pajunk Sonoplex, Lifetech, B. Braun Stimuplex D+) with a non-echogenic control (Pajunk Uniplex), using a novel assessment technique in unembalmed human cadavers. Multiple images were taken of each needle at shallow (15 to 25°), moderate (35 to 45°) and steep (55 to 65°) insertion angles. Twenty anaesthetists with varied experience in ultrasound-guided nerve blocks identified needle tip position and stated their confidence level in estimates. Actual tip position was determined at the time of image generation but concealed from the anaesthetists. Two-dimensional mapping of ‘tip-error’ involved measurement of the distance and orientation of each clinician's estimate of tip position in relation to the actual tip position. There were no significant differences in confidence or overall needle visibility at shallow insertion angles. At steeper angles, the Sonoplex showed significantly higher confidence and visibility scores. The remaining echogenic designs did not show any significant differences from the non-echogenic control. Objective measurements of tip error followed the same pattern as the subjective data, although were not universally significant. Two-dimensional mapping showed that as needle visibility deteriorated, so precise tip location was lost but the needle shaft/insertion path remained well-identified. As visibility deteriorated further, accuracy in this axis was also lost. When inaccurate, clinicians generally assessed the needle tip to be more superficial and inserted less far than it actually was. This has important implications for the safety of ultrasound-guided regional anaesthesia. Effective echogenic needle technology has the potential to address these concerns.

scholarly journals Ultrasound-guided Transversus Abdominis Plane Block for Neonatal Abdominal Surgery

2009 ◽  
Vol 37 (3) ◽  
pp. 469-472 ◽  
Author(s):  
M.J. Fredrickson ◽  
P. Seal
Keyword(s):  
Abdominal Surgery ◽  
Local Anaesthetic ◽  
Regional Anaesthesia ◽  
Transversus Abdominis Plane Block ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Ultrasound Guided ◽  
Wound Infiltration ◽  
Postoperative Ventilation ◽  
Upper Abdominal

This paper describes four neonates having abdominal procedures with intraoperative and early postoperative analgesia provided by a transversus abdominis plane regional block. Analgesia for neonatal upper and midabdominal surgery usually involves regional anaesthesia and/or systemic opioid. All these analgesia techniques have problems specific to the neonatal period. Neonates are sensitive to the respiratory depressant effects of systemic opioid, while the low threshold for local anaesthetic toxicity limits regional anaesthesia/analgesia, which in neonatal upper abdominal surgery is often limited to local anaesthetic infiltration. The transversus abdominis plane block has been shown to provide effective analgesia following a variety of abdominal surgeries in both adults and children. We report four neonates who underwent minor or major abdominal surgery under general anaesthesia supplemented by ultrasound-guided transversus abdominis plane block. Perioperative opioids were administered to one neonate who required postoperative ventilation. Ultrasound-guided transversus abdominis plane bock is a technically feasible alternative to local anaesthetic wound infiltration in the neonate and warrants further evaluation.

Regional anaesthesia

2021 ◽  
pp. 1099-1150
Author(s):  
Mark Fairley
Keyword(s):  
Nerve Injury ◽  
Upper Limb ◽  
Local Anaesthetic ◽  
Lower Limb ◽  
Regional Anaesthesia ◽  
Coagulation Disorders ◽  
Nerve Blocks ◽  
Safe Practice ◽  
Anaesthetic Agents

This chapter discusses the techniques of regional anaesthesia and analgesia. It begins with an overview of regional anaesthesia and goes on to describe safe practice, and local anaesthetic agents. Techniques of locating nerves are then discussed, including ultrasound, and needle design is explored. Nerve blocks of the neck; upper limb; trunk; lower limb, and the neuraxis (spine) are described. Coagulation disorders, nerve injury and the management of local anaesthetic toxicity are discussed. The chapter concludes with a dermatome map and tables of recommended nerve blocks for particular operations.

Regional anaesthesia

2020 ◽  
pp. 247-269
Author(s):  
Dr. Owen Davies
Keyword(s):  
Peripheral Nerve ◽  
Local Anaesthetic ◽  
Regional Anaesthesia ◽  
Epidural Haematoma ◽  
Nerve Injuries ◽  
Nerve Blocks ◽  
Ischaemic Injury ◽  
Peripheral Nerve Blocks ◽  
Surgical Emergencies ◽  
Life Threatening

There are a number of important emergencies associated with regional anaesthesia that the anaesthetist should be aware of. Life-threatening emergencies, such as local anaesthetic systemic toxicity leading to cardiorespiratory arrest can occur irrespective of the site of local anaesthetic infiltration. Specific procedures including epidural and spinal anaesthesia, eye blocks, and peripheral nerve blocks cause a range of surgical emergencies and severe complications. Neuraxial anaesthesia carries the risk of epidural haematoma and abscess while infiltration or local anaesthetic around the globe carries the risk of both retro-orbital haematoma and globe perforation, all of which may require urgent surgical intervention. Although literature supports the safety of low concentration (1 in 200 000) adrenaline as an additive to digital blocks, inadvertent injection of higher concentrations may have the potential for ischaemic injury. Finally, the assessment and diagnosis of perioperative nerve injuries when associated with a peripheral nerve block present a formidable clinical challenge.

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