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Safe Practice of Ultrasound Guided Regional Anesthesia

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Abstract

The practice of regional anesthesia incorporates a multitude of advanced techniques for understanding sonographic and surface anatomy, localizing peripheral nerves, as well as administering local anesthetic to these target nerves. While this subspecialty practice certainly necessitates a foundational knowledge in human anatomy and pharmacology, it also requires a basic understanding of ultrasound physics and electrophysiology. Here, we present a case to highlight the principal means of delivering a safe and effective regional anesthetic while simultaneously minimizing risks of adverse outcomes and preventing known complications.

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References

  1. Bingham AE, Fu R, Horn JL, Abrahams MS. Continuous peripheral nerve block compared with single-injection peripheral nerve block: a systematic review and meta-analysis of randomized controlled trials. Reg Anesth Pain Med. 2012;37(6):583–94. https://doi.org/10.1097/AAP.0b013e31826c351b.

    Article  CAS  PubMed  Google Scholar 

  2. Ilfeld BM. Continuous peripheral nerve blocks: an update of the published evidence and comparison with novel, alternative analgesic modalities. Anesth Analg. 2017;124(1):308–35. https://doi.org/10.1213/ANE.0000000000001581.

    Article  CAS  PubMed  Google Scholar 

  3. Vorobeichik L, Brull R, Bowry R, Laffey JG, Abdallah FW. Should continuous rather than single-injection interscalene block be routinely offered for major shoulder surgery? A meta-analysis of the analgesic and side-effect profiles. Br J Anaesth. 2018;120(4):679–92. https://doi.org/10.1016/j.bja.2017.11.104.

    Article  CAS  PubMed  Google Scholar 

  4. Marhofer D, Marhofer P, Triffterer L, Leonhardt M, Weber M, Zeitlinger M. Dislocation rates of perineural catheters: a volunteer study. Br J Anaesth. 2013;111(5):800–6. https://doi.org/10.1093/bja/aet198.

    Article  CAS  PubMed  Google Scholar 

  5. Bomberg H, Bayer I, Wagenpfeil S, Kessler P, Wulf H, Standl T, et al. Prolonged catheter use and infection in regional anesthesia: a retrospective registry analysis. Anesthesiology. 2018;128(4):764–73. https://doi.org/10.1097/ALN.0000000000002105.

    Article  PubMed  Google Scholar 

  6. Nouette-Gualain K, Capdevila X, Rossignol R. Local anesthetic ‘in-situ’ toxicity during peripheral nerve blocks: update on mechanisms and prevention. Curr Opin Anaesthesiol. 2012;25(5):589–95. https://doi.org/10.1097/ACO.0b013e328357b9e2.

    Article  CAS  Google Scholar 

  7. Ilfeld BM. Single-injection and continuous femoral nerve blocks are associated with different risks of falling. Anesthesiology. 2014;121:668–9. https://doi.org/10.1097/ALN.0000000000000358.

    Article  PubMed  Google Scholar 

  8. Jlala HA, Bedforth NM, Hardman JG. Anesthesiologists’ perception of patients’ anxiety under regional anesthesia. Local Reg Anesth. 2010;3:65–71. https://doi.org/10.2147/lra.s11271.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Horikawa H, Tada T, Sakai M, Karube T, Ichiyanagi K. Effects of midazolam on the threshold of lidocaine-induced seizures in the dog-comparison with diazepam. J Anesth. 1990;4(3):265–9. https://doi.org/10.1007/s0054000040265.

    Article  CAS  PubMed  Google Scholar 

  10. Sites BD, Taenzer AH, Herrick MD, Gilloon C, Antonakakis J, Richins J, et al. Incidence of local anesthetic systemic toxicity and postoperative neurologic symptoms associated with 12,668 ultrasound-guided nerve blocks: an analysis from a prospective clinical registry. Reg Anesth Pain Med. 2012;37(5):478–82. https://doi.org/10.1097/AAP.0b013e31825cb3d6.

    Article  CAS  PubMed  Google Scholar 

  11. Gray AT. Ultrasound-guided regional anesthesia. Current state of the art. Anesthesiology. 2006;104(2):368–73. https://doi.org/10.1097/00000542-200602000-00024.

    Article  PubMed  Google Scholar 

  12. Chapman GM. Regional nerve block with the aid of a nerve stimulator. Anaesthesia. 1972;27(2):185–93. https://doi.org/10.1111/j.1365-2044.1972.tb08195.x.

    Article  CAS  PubMed  Google Scholar 

  13. Gadsden JC. The role of peripheral nerve stimulation in the era of ultrasound-guided regional anaesthesia. Anaesthesia. 2021;76(Suppl 1):65–73. https://doi.org/10.1111/anae.15257.

    Article  PubMed  Google Scholar 

  14. Rosenberg PH, Veering BT, Urmey WF. Maximum recommended doses of local anesthetics: a multifactorial concept. Reg Anesth Pain Med. 2004;29(6):564–75. https://doi.org/10.1016/j.rapm.2004.08.003.

    Article  CAS  PubMed  Google Scholar 

  15. Capdevila X, Bringuier S, Borgeat A. Infectious risk of continuous peripheral nerve blocks. Anesthesiology. 2009;110(1):182–8. https://doi.org/10.1097/ALN.0b013e318190bd5b.

    Article  PubMed  Google Scholar 

  16. Fredrickson MJ, Kilfoyle DH. Neurological complication analysis of 1000 ultrasound guided peripheral nerve blocks for elective orthopaedic surgery: a prospective study. Anaesthesia. 2009;64(8):836–44. https://doi.org/10.1111/j.1365-2044.2009.05938.x.

    Article  CAS  PubMed  Google Scholar 

  17. Malchow RJ, Gupta RK, Shi Y, Shotwell MS, Jaeger LM, Bowens C. Comprehensive analysis of 13,897 consecutive regional anesthetics at an ambulatory surgery center. Pain Med. 2018;19(2):368–84. https://doi.org/10.1093/pm/pnx045.

    Article  PubMed  Google Scholar 

  18. Vasques F, Behr AU, Weinberg G, Ori C, Di Gregorio G. A review of local anesthetic systemic toxicity cases since publication of the American Society of Regional Anesthesia recommendations: to whom it may concern. Reg Anesth Pain Med. 2015;40(6):698–705. https://doi.org/10.1097/AAP.0000000000000320.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Yan H. Lai .

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Lee, T.S., Lai, Y.H. (2023). Safe Practice of Ultrasound Guided Regional Anesthesia. In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-21291-8_1

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  • DOI: https://doi.org/10.1007/978-3-031-21291-8_1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-21290-1

  • Online ISBN: 978-3-031-21291-8

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