Ultrasound in Peripheral, Neuraxial and Perineuraxial Regional Anaesthesia

Description

This comprehensive, highly didactic book on ultrasound-guided regional anesthesia (peripheral, neuraxial and perineuraxial nerve blocks) presents meticulously labelled images, diagrams and picture-in-picture samples and includes high-quality, vignetted illustrations that are consistent in style. The ultrasound images are outstanding and carefully selected to demonstrate the most clinically relevant situations. Importantly, they have a real-world appearance, including actual needle paths and desired disposition of injectate during nerve block procedures; most are from the original database of Dr. Eisenberg. All the supplementary material is authoritative and presented as an artful balance of years of clinical experience and a summary of the peer reviewed literature. Ultrasound in Peripheral, Neuraxial and Perineuraxial Regional Anaesthesia, accompanied by richly illustrated material and videos of state-of-the-art techniques, is of interest to anyone interested in learning, furthering their existing knowledge of, or teaching ultrasound-guided regional anesthesia.       Foreword From the Same Publisher Foreword to the 2014 French Edition Postscript to the 2014 French Edition Acknowledgements Contents Contributors 1: Physical Basis of Ultrasound History Physical Principles Ultrasound Image (Fig. 1.4) Transducers (Probes) Transmission Reception Principle of Image Formation A, B, M, 3D Mode, Tissue Harmonic Imaging, Real-Time Spatial Compound Imaging Main Artefacts Acoustic Shadowing Posterior Enhancement Multiple Echoes Anisotropy (Figs. 1.8 and 1.9) Ultrasound Velocimetry Continuous Doppler Ultrasound Pulsed Doppler Ultrasound (Fig. 1.10) Colour Doppler (Fig. 1.11) Doppler Energy or Angiographic Mode (Fig. 1.12) Biological Effects of Ultrasound The Ultrasonographer and the Quality of the Image Obtained Choice of Transducer Frequency Type of Transducer Adjustment of Settings Transmission of the Ultrasound Beam and Gain Adjustment of the Focal Points Reception of the Ultrasound Wave, Dynamic Range Pace of Imaging Choice of Techniques and Mode of Analysis of the Image How to Read an Ultrasound Image Superficial and Deep Planes Cephalic, Caudal, Lateral, Medial, Ventral, Dorsal Depth Studied Ultrasound Physical Findings (Table 1.2) References 2: Ultrasound in Regional Anaesthesia: Why and When? Limits of Neurostimulation Basis of Neurostimulation Neurostimulation and Ultrasonography Neurostimulation and Anatomical Variations RA and Obesity RA and Amputation Location of Pure Sensory Nerves Nerve Block by Diffusion Difficult or Impossible Neurostimulation Increase in Success Rate Patient Safety Decrease of Local Anaesthetic Doses Vascular Injection Decrease in Adverse Effects of Acute Systemic Toxicity Pneumothorax and Needle Puncture of an Adjacent Organ Locating the Spine Teaching A Conclusion for the Future: 3D or 4D Ultrasound? References 3: Ultrasound in Regional Anaesthesia: How? Equipment Ultrasound Systems Transducers Needles Nerve Stimulator The Ultrasound Transmission Gel Hygiene and Ultrasound-Guided RA Conduct of Ultrasound-Guided Peripheral Nerve Blocks Target Nerves Histology (Figs. 3.9 and 3.10) Ultrasound Image Needle “Out of Plane” Insertion Insertion “In Plane” How to Improve Vision of the Needle? Training of the Practitioner Visibility Factors Related to the Needle Visibility Factors Related to Artefacts Factors Related to Ultrasound Mode Needle/Ultrasound Beam Electromagnetic Follow-Up of the Needle (GPS) Various Techniques Method of Spread of the Local Anaesthetic “Appropriate” Neurostimulation Introduction Ultrasound-Guided Procedure: Place of Neurostimulation Algorithm for Practice of Ultrasonography in Combination with Neurostimulation in Conduct of a Perineural Block Conclusion General Principles for Conduct of Peripheral Nerve Blocks with a Single Injection, So-Called “Single-Shot” Nerve Blocks, Under Ultrasound Guidance Rules on Hygiene and on Monitoring Transcutaneous Location Equipment Needle Puncture Sites, Needle Trajectory Injection Procedures Approach How and When to Inject? What Volume of Local Anaesthetic to Inject? General Principles for Conduct of Continuous Peripheral Nerve Blocks with a Perineural Catheter Under Ultrasound Guidance Principal Sites of Insertion Indications Rules on Hygiene and Monitoring Transcutaneous Location Equipment Needle Puncture Site, Needle Trajectory Nerve in Transverse (Short Axis) View, Needle Puncture Out of Plane (Fig. 3.49b) Nerve in Transverse Section, Needle Puncture in Plane (Fig. 3.49a) Nerve in Longitudinal Section, Needle Puncture in Plane (Fig. 3.49c) Specific Aspects in Paediatric Patients Pharmacokinetic and Pharmacodynamic Specific Aspects in Children Pharmacokinetics Pharmacodynamics Practice RA Under General Anaesthesia: RA in the Awake Patient Equipment Safety RA Under Ultrasound Guidance Equipment Sonoanatomy Checklist for Conduct of an Ultrasound-Guided Peripheral Nerve Block Proposal for a Decision-Making Tree for Conduct of an Ultrasound-Guided Peripheral Nerve Block [135] (Fig. 3.53) New Techniques Under Development Electromagnetic Monitoring of the Needle (“GPS”) 3D/4D Fusion Imaging (CT-Scan Ultrasound/MRI-Ultrasound) Technical Considerations Preliminary Experience with US/CT and US/MRI Image Fusion Lumbar Spine Phantom US/CT Fusion US/MR Image Fusion of the Lumbar Spine in Volunteers Concluding Remarks References 4: General Notions of Anatomy Applied to Regional Anaesthesia The Nervous System General Organisation Dermatomes (Figs. 4.1, 4.2, and 4.3) Myotomes and Osteotomes (Figs. 4.4 and 4.5) Plexuses Cervical Plexus (Fig. 4.6) Brachial Plexus (Fig. 4.7) Lumbar Plexus (Fig. 4.8) Sacral Plexus (Fig. 4.9) Innervation of the Principal Joints Shoulder Elbow Wrist and Hand Hip Knee Ankle Motor Innervation of the Upper Limb (from Denis Jochum) (Table 4.1 and Fig. 4.10) Motor Innervation of Lower Limb (from Denis Jochum) (Fig. 4.11 and Table 4.2) References 5: Brachial Plexus Blocks Anatomy Among the Collateral Branches The Dorsal Scapular Nerve The Long Thoracic Nerve Pectoral Nerves Loop (Ansa Pectoralis), Medial and Lateral Pectoral Nerves Thoracodorsal Nerve Terminal Branches of the Brachial Plexus Axillary Nerve Radial Nerve Musculocutaneous Nerve Median Nerve Ulnar Nerve Medial Cutaneous Nerve of the Arm Medial Cutaneous Nerve of the Forearm Brachial Plexus Nerve Blocks Interscalene Block (Fig. 5.10) Indications Approach, Ultrasound Anatomy Posterolateral Approach (In Plane) (Fig. 5.12) Nerve Localisation Injection Interscalene Catheter by Posterolateral Approach (in the Ultrasound Plane) (Figs. 5.36, 5.37, 5.38, 5.39, 5.40, 5.41, and 5.42) Injection Short/Transverse Axis Approach (Needle Out of Plane) Supraclavicular Block (Fig. 5.49) Echoanatomy Pathways of Approach Lateral Approach Nerve Localisation Needle Insertion Injection Medial Approach Nerve Localisation Needle Insertion Injection Infraclavicular Block (Fig. 5.61) Indications Echoanatomy Approach Parasagittal Probe, Needle in Plane Nerve Localisation Needle Insertion Injection Axillary Nerve Block (Fig. 5.73) Indications Echoanatomy and Approach Nerve Localisation Injection Needle in Plane (Fig. 5.85) Needle Out of Plane Insertion of a Perineural Catheter Brachial Canal Block (Fig. 5.89) Indications Echoanatomy Localization Injection Distal Blocks of the Radial Nerve (Fig. 5.96) Indications Echoanatomy Localisation and Injection Distal Blocks of the Median Nerve (Fig. 5.109) Indications Echoanatomy Localisation and Injection Above the Elbow Joint Forearm Distal Blocks of the Ulnar Nerve (Fig. 5.120) Indications Echoanatomy and Localization Injection Ulnar Nerve Block in the Distal Arm Ulnar Nerve Block in the Proximal Forearm Ulnar Nerve Block in the Distal Forearm References 6: Lumbar Plexus Blocks Anatomy Iliohypogastric Nerve (IH) Ilioinguinal Nerve (II) Genitofemoral Nerve (GF) Lateral Cutaneous Nerve of the Thigh (LCT) Obturator Nerve Accessory Obturator Nerve Femoral Nerve Muscular Branches Cutaneous Branches Lumbar Plexus Blocks Lumbar Plexus Block by Posterior Approach (Fig. 6.3) Indications Echoanatomy and Location Conduct of the Block In Practice Femoral Nerve Block (Fig. 6.17) Indications Echoanatomy and Location of the Nerve Utility of Doppler Ultrasound Approach Injection Lateral Cutaneous Nerve Block of the Thigh (Fig. 6.38) Indications Echoanatomy Utility of Doppler Ultrasound Localisation Approach Injection Saphenous Nerve Block (Fig. 6.44) Indications Echoanatomy Utility of Doppler Ultrasound Approach and Localisation Injection Obturator Nerve Block (Fig. 6.49) Indications Echoanatomy and Location Utility of Doppler Ultrasound Approach and Injection Injection References 7: Sacral Plexus Blocks Anatomy Ventral Branches Nerve to Obturator Internus (L5-S1-S2) Nerve to Quadratus Femoris (L4-L5-S1) Dorsal Branches Nerve to Piriformis (S1-S2) Superior Gluteal Nerve (L4-L5-S1) Inferior Gluteal Nerve (L5-S1-S2) Posterior Cutaneous Nerve of the Thigh (S1-S2-S3) Terminal Branch Tibial Nerve Common Fibular Nerve Superficial Peroneal Nerve Deep Peroneal Nerve Blocks Sciatic Nerve Block by Infrapiriform Parasacral (IPPS) and Transpiriform Parasacral (TPPS) Approach (Fig. 7.5) Indications Echoanatomy Approach and Location Pathway Injection Sciatic Nerve Block in the Buttock Sciatic Nerve Block by Subgluteal Approach (Fig. 7.32) Indications Echoanatomy and Location Approach with Ultrasound Guidance Needle Puncture and Injection Sciatic Nerve Block in the Popliteal Space (Fig. 7.43) Indications Histology Echoanatomy Approaches with Ultrasound Guidance Location Approach Injection For Insertion of a Perineural Catheter Tibial Nerve Block at the Ankle (Fig. 7.71) Indications Echoanatomy Approach with Ultrasound Guidance Localisation Puncture Injection Nerve Block of the Common Peroneal Nerve along the Biceps Femoris and Neck of the Fibula (Fig. 7.76) Indications Echoanatomy Approaches and Location Injection References 8: Cervical Plexus Blocks Anatomy Nerve Structures Fascia and Planes of the Neck (Figs. 8.5 and 8.6) Indications Sonoanatomy and Location Needle Puncture and Injection Specific Points Carotid Surgery Surgery in Areas of Overlapping Innervation Complications and Side Effects Precautions and Contraindications References 9: Abdominal Wall Nerve Blocks Note to the Reader Anatomy of the Ventrolateral Wall of the Abdomen Ventrolateral Wall of the Abdomen (Figs. 9.1, 9.2, 9.3 and 9.4) External Oblique Muscle Internal Oblique Muscle Transversus Abdominis Muscle Rectus Abdominis Muscle Rectus Abdominis Muscle Sheath (Rectus Sheath) Fascia Transversalis Quadratus Lumborum Muscle Nerve Structures (Figs. 9.1 and 9.2) Intercostal Nerves from T7 to T11 Subcostal Nerve (12th Intercostal Nerve) Iliohypogastric Nerve Ilioinguinal Nerve Genitofemoral Nerve Vascular Supply of the Ventrolateral Wall of the Abdomen (Fig. 9.3) Deep Iliac Circumflex Artery Inferior Epigastric Artery Superior Epigastric Artery Ventrolateral Abdominal Wall Nerve Blocks General Data TAP Block Indications TAP Block in the Middle Axillary Line (Intercostal-Iliac) (Fig. 9.12) TAP Subcostal Block (Fig. 9.25) Iliohypogastric and Ilioinguinal Nerve Block (Fig. 9.32) Indications Echoanatomy Approach Nerve Blocks for the Quadratus Lumborum Plane (Fig. 9.39) Definition of Type I and Type II Nerve Blocks Indications Sonoanatomy and Approach Rectus Sheath Block (Fig. 9.47) General Considerations Indications [27–29] Echoanatomy Approaches Block of the Genital Branches of the Genitofemoral, Iliohypogastric, and Ilioinguinal Nerves (Fig. 9.57) Indications Echoanatomy Approaches Local Anaesthetic: What Strategy, What Product, What Volume, What Concentration? In Adults, a Few Proposals In Children References 10: Thoracic Paravertebral Block Indications Mechanism of Action Ultrasound-Guided Thoracic Paravertebral Block General Considerations Preparation Aseptic Technique Nerve Block with Patient Awake or under General Anaesthesia? Continuous Injection and Problem of Catheters Needles Expected Morphological Criteria Conduct Transverse Ultrasound Section Section Passing through the Transverse Process and the Adjacent Rib (Figs. 10.29 and 10.30) Section Passing through the Transverse Process and the Pleura (Figs. 10.31 and 10.32) Approach in Plane (Fig. 10.19) Approach out of Plane (Figs. 10.20 and 10.35) Single or Continuous Injection? Section Passing through the Vertebral Laminae and the Pleura (Figs. 10.39 and 10.40) Approach in Plane (Figs. 10.19 and 10.41) Approach out of Plane (Figs. 10.20 and 10.42) Single or Continuous Injection? Paramedian Sagittal Ultrasound Section Approach in Plane (Fig. 10.21) Approach out of Plane (Fig. 10.22) Single or Continuous Injection? Conclusion References 11: Peripheral Nerve Blocks of the Thoracic Ventrolateral Wall: Type I PECS Block, Type II PECS Block, and Serratus Plane Block Type I PECS Block Indications Sonoanatomy and Approach Type II PECS Block Indications Sonoanatomy and Approach Serratus Plane Block (SPB) Indications Sonoanatomy and Approach In Summary References 12: Ultrasound in Neuraxial and Perineuraxial Blocks Note to the Reader Introduction Indications for Central Neuraxial Anaesthesia Spinal Anaesthesia Unilateral Spinal Anaesthesia Saddle Block Anaesthesia Spinal Analgesia Continuous Spinal Anaesthesia Epidural Anaesthesia Lumbar Epidural Anaesthesia Thoracic Epidural Anaesthesia Anatomy of the Spine General Considerations Lumbar Spine (Fig. 12.1b) Thoracic Spine (Fig. 12.1c and d) General Data from the Literature History What Does Ultrasound Provide? Ultrasound Facilitates Identification of the Intervertebral Approach Ultrasonography Decreases the Technical Difficulty of Central Neuraxial Anaesthesia Can Use of Ultrasound Decrease the Risk of Complications? Can Use of Ultrasound Improve Clinical Efficacy of Central Neuraxial Anaesthesia? Central Neuraxial Anaesthesia at the Thoracic Level Techniques Basic Notions for Ultrasound in Central Neuraxial Anaesthesia Median Sagittal Paramedian Sagittal Paramedian Sagittal Oblique Median Transverse Equipment Preprocedural Ultrasound Localisation Real-Time Ultrasound Guidance Spinal Anaesthesia Epidural Anaesthesia Conclusions References