Ultrasound in Peripheral, Neuraxial and Perineuraxial Regional Anaesthesia

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