Basics of US Regional Anaesthesia - Anaesthesia UK PDF
Preview Basics of US Regional Anaesthesia - Anaesthesia UK
B US R asics of egional A naesthesia November 2008 Essential Physics HIGH frequency = great resolutionbut ppoooorr ppeenneettrraattiioonn LOW frequency = ppoooorr rreessoolluuttiioonn but great penetration Potential Advantages of US • No ionising radiation •• PPoorrttaabbiilliittyy • Robust • Advent of NICE has increased machine accessibility Potential Advantages of US • Identify target nerve - fascicular pattern, 90% of peripheral nerves have this pattern. • White / hyperechoic is peri/epineurium • Black / hypoechoic is nerve tissue Transverse Longitudinal Left interscalene More proximally where the nerve tissue is more dense the nerve can appear more hypoechoic – black bubbles with white borders. Potential Advantages of US • Identify surrounding structures e.g. blood vessels, pleura, peritoneum •• DDeetteerrmmiinnee bbeesstt aapppprrooaacchh ttoo ttaarrggeett nneerrvvee • Real time guidance • Patients with neuropathy do not respond normally to PNS • Observe local anaesthetic distribution Normal Anatomy ? Potential Advantages of US • Faster onset of block • Assess catheter position • Repeat block if extended surgery • Paralysed patient! Additional Advantages in Children • Under GA – warning signs of intravascular or intraneural injection may be masked •• SSmmaalllleerr mmaassss ssoo nneerrvveess mmoorree ssuuppeerrffiicciiaall ssoo allowing higher frequencies to be used • Less margin for error as vulnerable structures such as pleura are closer to nerves
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