Ultrasound-Guided Regional Anesthesia: A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters PDF
Preview Ultrasound-Guided Regional Anesthesia: A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters
Ultrasound-Guided Regional Anesthesia A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters Ultrasound-Guided Regional Anesthesia A Practical Approach to Peripheral Nerve Blocks and Perineural Catheters Fernando L. Arbona Babak Khabiri John A. Norton Illustrated by Charles Hamilton and Kelly Warniment CAMBRIDGE UNIVERSITY PRESS Cambridge,NewYork,Melbourne,Madrid,CapeTown,Singapore, SãoPaulo,Delhi,Dubai,Tokyo,MexicoCity CambridgeUniversityPress TheEdinburghBuilding,CambridgeCB28RU,UK PublishedintheUnitedStatesofAmericaby CambridgeUniversityPress,NewYork www.cambridge.org Informationonthistitle:www.cambridge.org/9780521515788 #CambridgeUniversityPress2011 Thispublicationisincopyright.Subjecttostatutoryexception andtotheprovisionsofrelevantcollectivelicensingagreements, noreproductionofanypartmaytakeplacewithout thewrittenpermissionofCambridgeUniversityPress. Firstpublished2011 PrintedintheUnitedKingdomattheUniversityPress,Cambridge AcatalogrecordforthispublicationisavailablefromtheBritishLibrary LibraryofCongressCataloging-in-PublicationData Arbona,FernandoL. Ultrasound-guidedregionalanesthesia:apracticalapproachto peripheralnerveblocksandperineuralcatheters/FernandoL.Arbona, BabakKhabiri,JohnA.Norton. p.;cm. Includesbibliographicalreferencesandindex. ISBN978-0-521-51578-8(Hardback) 1. Conductionanesthesia. 2. Operativeultrasonography. 3. Ultrasonicimaging. I. Khabiri,Babak. II. Norton,JohnA., 1971– III. Title. [DNLM:1. NerveBlock–methods. 2. Anesthesia,Local–methods. 3. Anesthetics,Local. 4. Catheterization,Peripheral–methods. 5. PeripheralNerves–ultrasonography. 6. Ultrasonography, Interventional–methods. WO300A666u2010] RD84.A732010 617.9064–dc22 2010008737 ISBN978-0-521-51578-8Hardback Additionalresourcesforthispublicationat www.cambridge.org/arbona CambridgeUniversityPresshasnoresponsibilityforthepersistenceor accuracyofURLsforexternalorthird-partyinternetwebsitesreferredto inthispublication,anddoesnotguaranteethatanycontentonsuch websitesis,orwillremain,accurateorappropriate. Everyefforthasbeenmadeinpreparingthisbooktoprovideaccurateand up-to-dateinformationwhichisinaccordwithacceptedstandardsand practiceatthetimeofpublication.Althoughcasehistoriesaredrawnfrom actualcases,everyefforthasbeenmadetodisguisetheidentitiesofthe individualsinvolved.Nevertheless,theauthors,editorsandpublisherscan makenowarrantiesthattheinformationcontainedhereinistotallyfree fromerror,notleastbecauseclinicalstandardsareconstantlychanging throughresearchandregulation.Theauthors,editorsandpublishers thereforedisclaimallliabilityfordirectorconsequentialdamagesresulting fromtheuseofmaterialcontainedinthisbook.Readersarestrongly advisedtopaycarefulattentiontoinformationprovidedbythemanufac- turerofanydrugsorequipmentthattheyplantouse. FernandoL. Arbona Thisbookisdedicatedtomywife,Melissa,andmythreebeauti- fuldaughters,Olivia,Sophia,andMia,whoprovidemewiththe love, support, and inspiration that help me in all of life’s endeavors. BabakKhabiri For my parents Badi Khabiri and Mahin Raz Khabiri who instilled in us a love for learning and helping others; and my threeolderbrothersRamin,Shahriar,andHoomanwhoshowed me the way. John A.Norton I would like to thank my wife Kavitha for always providing a foundation of loving support in my professional endeavors, and our beautiful children, J. P., Meera, and Joshua for their daily inspiration. v Contents Preface ix Acknowledgments xi – Section 1 Introduction 12 Sciatic nerve block: lateral popliteal fossa/distal thighapproach 101 13 Femoral peripheralnerveblock 116 1 Pharmacology: local anesthetics and additives 1 14 Ultrasound-assisted ankle block 125 2 Introduction to ultrasound 10 – Section 4 Peripheral perineural 3 Application ofultrasound in regional catheters anesthesia 24 – Section 2 Upper extremity peripheral 15 Introduction to continuous perineural nerve blocks catheters 133 16 Interscalene continuous perineural catheter 143 4 Upper extremity anatomy for regional 17 Supraclavicularcontinuous perineural anesthesia 31 catheter 152 5 Interscalene brachial plexus block 37 18 Infraclavicular continuous perineural 6 Supraclavicularbrachial plexus block 49 catheter 160 7 Infraclavicular brachial plexus block 58 19 Sciatic continuous perineural catheters: proximal and lateral 8 Axillaryperipheral nerve blocks 68 popliteal fossa 170 9 Additional upperextremity peripheral 20 Femoral continuous perineural nerve blocks 78 catheter 182 – Section 3 Lower extremity peripheral nerve blocks Index 191 Freeaccesswebsiteatwww.cambridge.org/arbona 10 Lower extremity anatomy for regional containingnumerousultrasoundloopsandvideo anesthesia 83 clipsshowingnerveblockandperineuralcatheter 11 Sciatic nerve block: proximal techniques being performed. approaches 89 vii Preface Ultrasound guidance in regional anesthesia provides techniquesisprovided.Forthebeginner,thesechapters real-time imaging during the placement of nerve areimportant,andtheyarewrittentobeeasytofollow blocks and perineural catheters, improving patient with information and nomenclature that will become comfort, decreasing many procedure times, and commonplaceasyouimplementultrasoundintoyour revealing valuable anatomic information, which may practice. enhance patient safety. It therefore comes as no sur- Themiddle sectionsofthetext(Sections2and3) prisethattheuseofultrasoundinregionalanesthesia discuss the placement of ultrasound-guided single- continues to grow in popularity, opening new doors shotregionalblocksthatcanberoutinelyusedinmost to physicians in their practice where barriers may busy anesthesia practices. Section 2 focuses on upper have once existed. As regional anesthesiologists, we extremity peripheral nerve blocks, while Section 3 have written this text for residents, fellows, and staff turns to blocks of the lower extremity. Each chapter physicians desiring to learn and begin incorporating is introduced with a discussion of pertinent anatomy the use of ultrasound into the scope of their busy in the block region. An understanding of anatomical practices. structures and relationships is key when ultrasound This book introduces the use of ultrasound tech- imaging is undertaken during scanning and block nology for the placement of peripheral nerve blocks placement. All chapters provide specific instruction andperineuralcatheters.Ourgoalinwritingthistext onblockselectionandsetup,needlepositioning,local wastoprovideaneasy-to-readsourceofinformation anestheticinjection,andtroubleshooting. with particular attention to the steps and detail Section 4 includes chapters detailing the practical involved with ultrasound imaging, as well as block placement and positioning of continuous perineural and catheter placement. cathetersunderultrasoundguidance.Wefeelthisisa We have organized the text into four major unique feature of this text. sections, beginning with chapters to introduce basic While we do summarize procedures for quick, concepts in regional anesthesia including local anes- easy reference, portions of each procedural chapter thetics, ultrasound physics and imaging, as well as arewrittenasiftheinstructorwerethereperforming anatomy. The chapter on local anesthetics is written the block with you. Further, our “Key points” or to convey basic pharmacologic concepts about the “Additional considerations” paragraphs outlined medications commonly used in peripheral nerve within the text of each chapter are there to provide blocks. Multiple, more in-depth sources other than additional hints, reminders, or instructions, which thistextareavailableforreview.Ourintentionhereis mayimproveblocksuccessorenhancesafetyinyour to introduce agents common to the practice of practice. regional anesthesia with concise, retainable informa- Much of the information in these chapters we tion for anesthesiaproviders. draw from our own experience as instructors at a Theintroductiontoultrasoundisdividedintotwo major academic medical center and a fast-paced separate chapters (Chapters 2 and 3). The first of ambulatory setting. The “Authors’ clinical practice” thesechaptersdiscussesbasicprinciplesofultrasound sections highlight our own personal practice and physics and imaging, while the second covers the opinions regarding topics covered in the preceding current utilization of this technology in a regional chapter.Wedevelopedthesediscussionsasa“seehow anesthesia setting. An in-depth discussion of probe we do it” section for quick, easy reference at the end ix manipulation,imageoptimization,andtroubleshooting ofeachchapter.Thesearetheanswerstoquestionswe Preface are often asked when teaching these techniques. later for quick and easy review. And just as we teach Though we do not attest that this is always the pre- our residents, we advocate becoming proficient ferredorbestwaytoachieveaspecificdesiredresult, with single-shot peripheral nerve blocks utilizing wehavefoundthepointsmadeinthesediscussionsto ultrasound before attempting perineural catheter bemost efficaciousin our own practice. placement. Forthosenewtoultrasoundinregionalanesthesia This book was written to organize and convey to anda particular block approach,we find thebestuse others the instruction we use and teach in our daily ofthisbookisinreviewofthedetail-orientedsections practice. If you are interested in picking up an ultra- prior to undertaking new techniques. Summary soundprobetoassistwithyournextperipheralnerve sections within each chapter can then be referred to block, this book was written foryou. x
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