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Regional Nerve BlocksBenefts

•

Provide better post-op painmanagement

• Limit block to the body part undergoingsurgery

• Reduced need or other analgesicsopioids!

• "ecreased P#N$

•

%inimal side e&ects

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'onventional (echni)ue

• "efne area to be blocked

based on suracelandmarks

• *nsert stimulating catheter

• 'onfrm location +ith

nerve stimulator +atchingor appropriate motorresponse

•  *n,ect anesthetic

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'onventional

Nerve Block

Procedures

are

perormed+ithout visual

guidance

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Role o Ultrasound Guidance• ee the target avoid the danger

 – $isuali.e nerve and surrounding vascular/pleural

structures

• Provides real time guidance

• *mproves accuracy

• #bserve anesthetic spread• U guidance 0may1 prevent intraneural

in,ury and improve block saety ande&ectiveness

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Ultrasound 2ppearanceNerves can have 3 shapes4

•   Round• #val

•  (riangular 

Peripheral Nerve

CervicalNerve Roots

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Ultrasound 2ppearance

Peripheral Nerve

CervicalNerve Roots

'ervical Roots

•  %onoascicularappearance

•  "ark5ypoechoic

Peripheral Nerves

•

 5oneycombappearance

•  5yperechoic

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Needle 2ppearance

Needle shaft

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Ultrasound 2ppearance• *dentiy

ad,acentvascularstructures

•

6asy to identiy+ith 'olor"oppler

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Nerve Pre/Post *n,ection

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Nerve Pre/Post *n,ection

Nerve

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Nerve Pre/Post *n,ection

Nerve

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U Guided Nerve Blocks

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 (ransducer Placement 1. Interscalene

2. Supraclavicular 

3. Infraclavicular 

4-5 Axillary

Picture rom 2nesthesiology 78839::4;

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*nterscalene 2pproach• Used to visuali.e roots o the

brachial ple=us• Brachial ple=us nerve lies in-

bet+een the anterior and middle

scalene muscles• 2ppear round to oval hypoechoic

structures

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Brachial Ple=us

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Brachial Ple=us

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Brachial Ple=us/*nterscalene

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Brachial Ple=us/*nterscalene

SCM

ASM

MSM

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Nerve Pre/Post *n,ection

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upraclavicular 2pproach• Block brachial ple=us at level o

the nerve trunks or divisions• 2ssociated +ith high level o

pneumothora=

•

Not generally recommended oroutpatients

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upraclavicular 2pproach

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ummaryUltrasound guidance• ho+s e=act nerve location•

ho+s vital structures surroundingnerves• Provides real-time guidance or needle

advancement•

*mproves accuracy• *dentifes local anesthetic spread• *ncrease patient satisaction

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“Regional AnesthesticTechniques have a failure rate ofup to 20% because of incorrectneedle and/or local anesthestic

 placement.”

incent !han" 200# A $ractical uide to &ltrasound 'maging

(or $eripheral )erve *loc+s

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>uestions?