Abstract
Purpose
This study demonstrated the effects of perfluorobutane (Sonazoid®) with contrast-enhanced ultrasonography (CEUS) to identify the spread of local anesthetics in ultrasound-guided nerve block.
Methods
This study consists of simulation, cadaveric, and animal studies. In a simulation study, 1% lidocaine with 10- to 1000-fold diluted Sonazoid®, a US-specific contrast agent to diagnose hepatic and breast cancers (0.5 mL), was injected into a resin-based phantom to determine the optimal concentration for ultrasound-guided peripheral nerve block. The enhanced area was measured by direct observation and ultrasonography (US). In the cadaver study, ultrasound-guided sciatic nerve block was performed at the popliteal fossa in the 9 extremities, and 5 mL of the optimally diluted Sonazoid® defined in the simulation study with X-ray contrast medium and blue dye was injected. Longitudinal spread of the solution was measured by CEUS, X-ray imaging and anatomical dissection. In the animal study, the optimally diluted Sonazoid® was injected around the sciatic nerve of rats (n = 6), and neuronal function and toxicity were evaluated by behavioral and histological estimation.
Results
The simulation study proved that 100-fold diluted Sonazoid® was the optimal concentration. In the cadaver study, CEUS and anatomical dissection (r = 0.90, P = 0.0020) or radiography (r = 0.84, P = 0.0072) showed high agreement and correlation with the longitudinal spread. CEUS clearly showed a fine intraneuronal injection image compared to the usual B-mode imaging. The animal study suggested no adverse effects by co-administration of lidocaine and Sonazoid®.
Conclusions
CEUS with 100-fold diluted Sonazoid® could identify the spread of local anesthetic as well as radiography and anatomical dissection, and distinguish between intra- and extraneuronal injections without neurodegeneration.
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Acknowledgements
We wish to thank to Professor Mineko Fujimiya (Department of Anatomy, Sapporo Medical University School of Medicine) for the preparation of Thiel-embalmed cadavers, and Tomohisa Niiya, Takeshi Murouchi, Eri Gi and Syunsuke Hayashi (Department of Anaesthesiology, Sapporo Medical University School of Medicine) for their excellent assistance. This work was supported by the Japan Society for the Promotion of Science KAKENHI Grant-in-Aid (Numbers: 25861388, 24592350).
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Sasaki, H., Yamauchi, M., Ninomiya, T. et al. Possible utility of contrast-enhanced ultrasonography for detecting spread of local anesthetic in nerve block. J Anesth 31, 365–373 (2017). https://doi.org/10.1007/s00540-017-2347-x
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DOI: https://doi.org/10.1007/s00540-017-2347-x