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  • Upper Extremity Block

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    Regional nerve blocks provide better post-operative pain management and reduce the need for opioids when used for surgeries. Conventionally, these blocks are performed without visual guidance by identifying the target area using surface landmarks and stimulating the nerve. Ultrasound guidance allows physicians to visualize the target nerve and surrounding structures in real-time, improving the accuracy of needle placement and observation of local anesthetic spread. It may also prevent injuries by avoiding intraneural injection. Nerves appear round, oval, or triangular under ultrasound and can be distinguished from adjacent blood vessels using Doppler. Ultrasound improves the success rate of regional nerve blocks over conventional techniques by directly viewing nerve location and spread of the anesthetic.

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    Regional nerve blocks provide better post-operative pain management and reduce the need for opioids when used for surgeries. Conventionally, these blocks are performed without visual guidance by identifying the target area using surface landmarks and stimulating the nerve. Ultrasound guidance allows physicians to visualize the target nerve and surrounding structures in real-time, improving the accuracy of needle placement and observation of local anesthetic spread. It may also prevent injuries by avoiding intraneural injection. Nerves appear round, oval, or triangular under ultrasound and can be distinguished from adjacent blood vessels using Doppler. Ultrasound improves the success rate of regional nerve blocks over conventional techniques by directly viewing nerve location and spread of the anesthetic.

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    11 views25 pages

    Upper Extremity Block

    Uploaded by

    abudsatria
    Regional nerve blocks provide better post-operative pain management and reduce the need for opioids when used for surgeries. Conventionally, these blocks are performed without visual guidance by identifying the target area using surface landmarks and stimulating the nerve. Ultrasound guidance allows physicians to visualize the target nerve and surrounding structures in real-time, improving the accuracy of needle placement and observation of local anesthetic spread. It may also prevent injuries by avoiding intraneural injection. Nerves appear round, oval, or triangular under ultrasound and can be distinguished from adjacent blood vessels using Doppler. Ultrasound improves the success rate of regional nerve blocks over conventional techniques by directly viewing nerve location and spread of the anesthetic.

    Copyright:

    © All Rights Reserved
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    of 25

    Ultrasound Guided Regional Nerve Blocks

    Regional Nerve Blocks


    Benefits
    Provide better post-op pain
    management
    Limit block to the body part undergoing
    surgery
    Reduced need for other analgesics
    (opioids)
    Decreased PONV
    Minimal side effects

    Conventional Technique
    Define area to be blocked
    based on surface
    landmarks
    Insert stimulating catheter
    Confirm location with
    nerve stimulator watching
    for appropriate motor
    response
    Inject anesthetic

    Conventional
    Nerve Block
    Procedures
    are
    performed
    without visual
    guidance

    Role of Ultrasound Guidance


    See the target avoid the danger
    Visualize nerve and surrounding vascular/pleural
    structures

    Provides real time guidance


    Improves accuracy
    Observe anesthetic spread
    US guidance may prevent intraneural
    injury and improve block safety and
    effectiveness

    Ultrasound Appearance
    Nerves can have 3 shapes:
    Round

    Oval
    Triangular

    Cervical
    Nerve Roots

    Peripheral Nerve

    Ultrasound Appearance
    Cervical Roots
    Monofascicular
    appearance
    Dark
    Hypoechoic
    Peripheral Nerves
    Honeycomb
    appearance
    Hyperechoic

    Cervical
    Nerve Roots

    Peripheral Nerve

    Needle Appearance

    Needleshaft

    Ultrasound Appearance
    Identify
    adjacent
    vascular
    structures
    Easy to identify
    with Color
    Doppler

    Nerve Pre/Post Injection

    Nerve Pre/Post Injection

    Nerve

    Nerve Pre/Post Injection

    Nerve

    US Guided Nerve Blocks

    Transducer Placement
    1. Interscalene
    2. Supraclavicular

    3. Infraclavicular

    4-5 Axillary

    Picture from Anesthesiology 2003;99:42

    Interscalene Approach
    Used to visualize roots of the
    brachial plexus
    Brachial plexus nerve lies inbetween the anterior and middle
    scalene muscles
    Appear round to oval hypoechoic
    structures

    Brachial Plexus

    Brachial Plexus

    Brachial Plexus/Interscalene

    Brachial Plexus/Interscalene
    SCM
    ASM
    MS
    M

    Nerve Pre/Post Injection

    Supraclavicular Approach
    Block brachial plexus at level of
    the nerve trunks or divisions
    Associated with high level of
    pneumothorax
    Not generally recommended for
    outpatients

    Supraclavicular Approach

    Summary
    Ultrasound guidance
    Shows exact nerve location
    Shows vital structures surrounding
    nerves
    Provides real-time guidance for needle
    advancement
    Improves accuracy
    Identifies local anesthetic spread
    Increase patient satisfaction

    Regional Anesthestic
    Techniques have a failure rate of
    up to 20% because of incorrect
    needle and/or local anesthestic
    placement.
    Vincent Chan, 2004
    A Practical Guide to Ultrasound Imaging
    For Peripheral Nerve Blocks

    Questions?

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