Ultrasound regional anesthesia

BACKGROUND: Radiofrequency ablation (RFA) is a common method for alleviating chronic back pain by targeting and ablating of facet joint sensory nerves. High-intensity focused ultrasound (HIFU) is an emerging, non-invasive, image-guided technology capable of providing thermal tissue ablation. While HIFU shows promise as a potentially superior option for ablating sensory nerves, its efficacy needs validation and comparison with existing methods. METHODS: Nine adult pigs underwent fluoroscopy-guided HIFU ablation of eight lumbar medial branch nerves, with varying acoustic energy levels: 1000 (N=3), 1500 (N=3), or 2000 (N=3) joules (J)...

BACKGROUND: While fluoroscopic guidance is currently the imaging standard for cervical medial branch blocks (CMBBs), ultrasound guidance (USG) offers several potential safety advantages such as real-time needle visualization and the ability to detect and avoid critical soft tissue vascular or neural structures. However, no large-scale trials have examined the safety of USG for CMBB. METHODS: Five hundred patients undergoing 2308 individual block levels were recruited using a prospective cohort design, and blocks were performed in an outpatient office setting using an in-plane USG technique...

OBJECTIVES: Ultrasound-guided superior laryngeal nerve (SLN) block is a practical and painless approach to avoid the hemodynamic stress response during endotracheal intubation and relieve sore throat after laryngeal surgery. The main purpose of this study was to establish an optimal dosage of local anesthetic when performing SLN block to help anesthetists balance analgesia and side effects. METHODS: Twenty fresh larynx specimens were obtained immediately after resection and then injected with 2-, 3-, 4-, or 5- mL of a lidocaine-blue dye mixture at bilateral SLN puncture sites...

Abdominal pain is one of the most common presenting chief complaints in the emergency department (ED). Erector spinae plane block (ESPB) is an ultrasound-guided nerve block with proven effectiveness in treating visceral and somatic abdominal pain. Despite the increasing popularity of ESPB, its role in the management of non-surgical abdominal pain has not yet been characterized. Our scoping review aims to review the current literature on the safety and efficacy of ESPB in the management of patients experiencing intractable, non-surgical abdominal pain...

BACKGROUND: In recent years, the suprainguinal fascia iliaca compartment block (SFICB) has become more common in clinical practice. This assessor-blinded dose-finding study aimed to determine the minimum effective concentration (MEC90, MEC95) of bupivacaine for a single-injection SFICB in patients undergoing arthroscopic anterior cruciate ligament repair. METHODS: This prospective study was conducted at a tertiary hospital (postoperative recovery room and ward)...

The aim of this study was to describe one-point (preiliac approach) and two-point (preiliac and retrocostal approach) blocks of the Transversus Abdominis Plane (TAP) on a cadaveric model. For this purpose, ultrasound-guided infiltration of the plane between the internal oblique and transversus abdominis muscles was performed and, after dissection of tissues, the areas and percentage of nerve fibers involved were analyzed. Injection into the TAP plexus of a 1 mL/kg solution of 2% lidocaine and 1% methylene blue (1:1) was performed in 30 rabbit cadavers...

PURPOSE: The purpose of this study was to evaluate the efficacy of percutaneous cryoablation in the treatment of abdominal wall endometriosis (AWE) nodules. MATERIALS AND METHODS: Thirty-eight women treated for symptomatic AWE nodules with percutaneous cryoablation under ultrasound and computed tomography (CT) guidance between May 2020 and July 2023 were retrospectively included. Pain was estimated using visual analog scale (VAS) and assessed at baseline, three months, six months, and 12 months after percutaneous cryoablation...

BACKGROUND: Novel interfascial plane blocks like PEricapsular Nerve Group (PENG) and SupraInguinal Fascia Iliaca (SIFI) blocks are effective for management of hip fracture pain. We compared the difference in the distribution of the dye injected and nerves stained by the addition of the SIFI block to the PENG block. METHODS: A total of 24 designated dye injections were performed in eight soft-embalmed cadavers. Under ultrasound guidance 20 ml green ink injected bilaterally in PENG block and 30 ml methylene blue dye was injected in the SIFI block on the right side...

Lung ultrasound (LUS) is widely used as a diagnostic and monitoring tool in critically ill patients. Lung ultrasound score (LUSS) based on the examination of twelve thoracic regions has been extensively validated for pulmonary assessment. However, it has revealed significant limitations: when applied to heterogeneous lung diseases with intermediate LUSS pattern (LUSS 1 and 2), for instance, intra-observer consistency is relatively low. In addition, LUSS is time-consuming and a more rapid overview of the extent of lung pathology and residual lung aeration is often required, especially in emergency setting...

This study describes a transversal (TV) ultrasound-guided erector spinae plane (ESP) block technique over the transverse process of T12. And evaluates the distribution of the dye and affected nerves branches compared to a longitudinal (LNG) approach over the transverse process of T12 in canine cadavers. Secondly, it also compares de anatomy and dimensions of the transverse processes of T12 with T9 and T5. For this double-masked, cadaveric experimental study, 12 adult Beagle cadavers were injected with 0.6mL/kg of dye/contrast...

BACKGROUND: Extremity amputations are associated with pain in both the residual limb and the phantom limb. This pain, which is often debilitating, may be prevented by excellent perioperative pain control. Ultrasound-guided percutaneous cryoneurolysis is an analgesic modality offering pain control for weeks or months following surgery. This treatment has not been compared to the sham procedure for large nerves (e.g., femoral and sciatic) to provide preoperative analgesia. We therefore conducted a randomized, controlled pilot study to evaluate the use of this modality for the treatment of pain following amputation to (1) determine the feasibility of and optimize the study protocol for a subsequent definitive clinical trial; and (2) estimate analgesia and opioid reduction within the first postoperative weeks...

BACKGROUND: Continuous peripheral nerve blocks are commonly used for pain management. However, the incidence of catheter dislodgement or migration is unclear, and may be underestimated and underreported. Our objective was to assess suprascapular catheter tip positioning before and after routine simulated shoulder physiotherapy manipulation in an anatomical cadaver model. METHOD: Eight ultrasound-guided continuous suprascapular nerve block catheters were placed in cryopreserved fresh cadavers...

The PENG block (Pericapsular Nerve Group) is a recently described technique to address the innervation of the hip, one of the most complex anatomical regions to treat at the locoregional level. We present the case of a patient with acute lymphoblastic leukemia complicated by avascular necrosis of the bilateral femoral head and previous history of severe chronic pain with probable central sensitization to opioids and a severe thrombocytopenia due to myelotoxicity from chemotherapy treatment. Given the need for orthopedic surgery to manage femoral necrosis and in anticipation of complex perioperative pain management, a multimodal strategy was planned including bilateral ultrasound-guided continuous PENG blocks to achieve proper pain control in the perioperative period and promote early recovery...

BACKGROUND: Erector spine plane block (ESPB) has been widely used in spinal surgery, although there are variable data about its efficacy. OBJECTIVES: This study aimed to evaluate the efficacy of ESPB in elective lumbar spinal fusion surgery patients with two different surgical approaches. MATERIALS AND METHODS: Retrospectively, 45 elective lumbar transpedicular fusion (TPF) surgery patients undergoing open surgery with different approaches [posterior transforaminal fusion approach (TLIF) or combined posterior and anterior approach (TLIF+ALIF)] were divided into 2 groups: general anesthesia (GA, n  = 24) and general anesthesia combined with ESPB (GA + ESPB, n  = 21)...

BACKGROUND: Patients diagnosed with Heart Failure with Reduced Ejection Fraction (HFrEF) are at high risk of perioperative cardiovascular complications. While it is important to focus on optimizing their cardiac function, it is also crucial to address and optimize any other modifiable risk factors that could potentially impact postoperative outcome. This also includes careful consideration of anesthetic techniques to suit the patient and facilitate the surgery. However, there is a scarcity of evidence regarding the safety of specific anesthetic approaches for heart failure patients...

BACKGROUND: The test dose or hydrolocation technique allows rapid detection of spread location. Though its primary aim is to enhance safety in peripheral nerve blocks, evidence on the potential risks of an intraneural test aliquot is lacking. We conducted a cadaveric study to evaluate the risk of fascicular injury following a low-volume (<1 mL) intraneural injection of the median nerve. METHODS: Ten upper limbs from fresh unembalmed human cadavers were studied...

Opioid use after kidney transplant has been associated with an increased risk of death and graft loss. Several transplant centers have reported reductions in opioid use using multimodal analgesia and education. This study evaluated the impact of an opioid minimization protocol on inpatient opioid use and opioid prescribing on discharge. This was a single-center, retrospective study of adult kidney recipients transplanted from October 2021 to July 2022. Patients on chronic opioids prior to transplant were excluded...

Ultrasound phantoms - alternatives to live human tissue - give learners the opportunity to practice ultrasound-guided regional anesthesia without introducing undue risk to patients. Gelatin-based phantoms provide educators with durable and reusable task trainers; however, commercially available gel-based phantoms are expensive. Here, we investigate the production of durable, low-cost, ballistic gel-based ultrasound phantoms for median, femoral, suprainguinal fascia iliaca plane, and serratus anterior plane nerve blocks, as well as a methodology for producing a phantom for any ultrasound-guided nerve block procedure...

Background and aim The regional anesthesia technique is commonly used for upper extremity surgery as an alternative to general anesthesia. The study aimed to compare the efficacy of infraclavicular brachial plexus block (BPB) and a combination of infraclavicular brachial plexus block with suprascapular nerve block for postoperative analgesia in patients undergoing shoulder surgeries. Method A total of 62 patients of both sexes with the American Society of Anaesthesiologists (ASA) physical status I/II/III, aged between 18 and 65 years, and undergoing shoulder surgery, were included in this prospective, single-blinded, randomized controlled trial...

BACKGROUND: Regional anesthesia is the favored choice in ruminant animals compared to general anesthesia, primarily due to its high safety margin and reduced demand for cost-intensive equipment in addition to its field applicability. Ultrasound-guided nerve block has gained significant attention in the field of veterinary medicine. This study utilized twenty-seven sheep of the native Rahmani breed to both demonstrate and evaluate the effectiveness of the ultrasound guided inferior alveolar nerve block technique...