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ultrasound in regional anaesthesia

Arunangshu Chakraborty, Rakhi Khemka, Taniya Datta
The practice of regional anaesthesia is rapidly changing with the introduction of ultrasound into the working domain of the anaesthesiologist. New techniques are being pioneered. Among the recent techniques, notable are the truncal blocks, for example, the transversus abdominis plane block, rectus sheath block, hernia block and quadratus lumborum block in the abdomen and the pectoral nerves (Pecs) block 1 and 2, serratus anterior plane block and intercostal nerve block. This narrative review covers the brief anatomical discourse along with technical description of the ultrasound-guided truncal blocks...
October 2016: Indian Journal of Anaesthesia
David Eldred-Evans, Veeru Kasivisvanathan, Fahd Khan, Mieke Van Hemelrijck, Alexander Polson, Peter Acher, Richard Popert
PURPOSE: Systematic transrectal ultrasound biopsies have been the first-line biopsy strategy in men with suspected prostate cancer for over 30 years. Transperineal biopsy is an alternative approach but has been predominately reserved as a repeat biopsy strategy and not widely used as a first-line approach. This study evaluates the diagnostic and clinical outcomes of transperineal sector biopsy (TPSB) as a first-line biopsy strategy in the diagnosis and management of prostate cancer. MATERIALS AND METHODS: A multi-institutional review of 402 consecutive patients who underwent primary transperineal sector biopsy...
October 10, 2016: Urology Journal
Ki Jinn Chin, Javier E Cubillos, Husni Alakkad
BACKGROUND: Regional anaesthesia comprising axillary block of the brachial plexus is a common anaesthetic technique for distal upper limb surgery. This is an update of a review first published in 2006 and previously updated in 2011 and 2013. OBJECTIVES: To compare the relative effects (benefits and harms) of three injection techniques (single, double and multiple) of axillary block of the brachial plexus for distal upper extremity surgery. We considered these effects primarily in terms of anaesthetic effectiveness; the complication rate (neurological and vascular); and pain and discomfort caused by performance of the block...
September 2, 2016: Cochrane Database of Systematic Reviews
K El-Boghdadly, C Madjdpour, K J Chin
Thoracic paravertebral blocks (TPVBs) have an extensive evidence base as part of a multimodal analgesic strategy for thoracic and breast surgery and have gained popularity with the advent of ultrasound guidance. However, this role is poorly defined in the context of abdominal surgery. We performed a systematic review of randomized controlled trials, to clarify the impact of TPVB on perioperative analgesic outcomes in adult abdominal surgery. We identified 20 published trials involving a total of 1044 patients that met inclusion criteria; however there was significant heterogeneity in terms of type of surgery, TPVB technique, comparator groups and study quality...
September 2016: British Journal of Anaesthesia
Arslane Alilet, Pascal Petit, Benedicte Devaux, Corinne Joly, Emmanuel Samain, Sebastien Pili-Floury, Guillaume Besch
INTRODUCTION: The value of ultrasound guidance for intermediate cervical blocks in patients undergoing carotid artery endarterectomy is poorly described. This study aimed at comparing the efficacy of ultrasound-guided intermediate cervical block to superficial cervical block for carotid artery endarterectomies. PATIENTS AND METHODS: We conducted a single-centre randomized-controlled study in a French University Hospital, from April 2011 to March 2012. The anaesthesia technique was randomly allocated to patients scheduled for carotid artery endarterectomy under regional anaesthesia (ropivacaine 4...
July 29, 2016: Anaesthesia, Critical Care & Pain Medicine
Concetta Leggieri, Francesca Guasina, Paolo Casadio, Alessandro Arena, Gianluigi Pilu, Renato Seracchioli
A 36 year old woman presented with pelvic pain and vaginal blood loss and interstitial pregnancy (single gestational sac located in the proximity of the right uterine horn, without visualization of embryo and/or attachments inside) on 2 and 3 dimensional ultrasonographic examination. The patient was clinically stable, abdomen was soft with normal peristalsis, superficial and deep palpation were painless as was decompression. Under general anaesthesia, an operative hysteroscopy was performed visually via ultrasound...
July 20, 2016: Journal of Minimally Invasive Gynecology
Thomas F Bendtsen, Stephen Haskins, Jens Aage Kølsen Petersen, Jens Børglum
It has been suggested for many years that regional anaesthesia is advantageous in high-risk patients, either as the sole anaesthetic or in combination with general anaesthesia. Regional techniques are safe and even more so when guided by ultrasound. In the high-risk patient population, ultrasound-guided regional anaesthesia (UGRA) can help decrease risk of perioperative morbidity and improve short-term as well as long-term outcomes, particularly in the orthopaedic, vascular, oncologic and chronic pain patient populations...
June 2016: Best Practice & Research. Clinical Anaesthesiology
M A Corvetto, J Carmona, M I Vásquez, C Salgueiro, J Crostón, R Sosa, V Folle, F R Altermatt
OBJECTIVE: A survey was conducted in order to obtain a profile of the practice of regional anesthesia in South America, and determine the limitations of its use. METHODS: After institutional ethics committee approval, a link to an online questionnaire was sent by e-mail to anaesthesiologists in Argentina, Bolivia, Chile, Colombia, Panamá, Paraguay, Perú, and Uruguay. The questionnaire was processed anonymously. RESULTS: A total of 1,260 completed questionnaires were received...
July 1, 2016: Revista Española de Anestesiología y Reanimación
N A Duce, L Gillett, J Descallar, M T Tran, S C M Siu, A Chuan
BACKGROUND: The knowledge on the type and influence of visuospatial ability on sonography performance relevant for ultrasound-guided regional anaesthesia remains incomplete. The aim of this study was to determine whether four different factors of visuospatial ability are important in determining proficiency and procedure time of novices performing brachial plexus sonography. These factors were spatial visualisation, flexibility of closure, spatial relations and speed of closure. METHODS: Thirty-three ultrasound novices were recruited in this prospective, observational trial...
September 2016: Acta Anaesthesiologica Scandinavica
J Defosse, M Schieren, A Böhmer, V von Dossow, T Loop, F Wappler, M U Gerbershagen
BACKGROUND/OBJECTIVE: This study's objective was to evaluate current thoracic anaesthesia practice in Germany and to quantify potential differences depending on the hospital's level of care. MATERIALS AND METHODS: A four-part online survey containing 28 questions was mailed to all anaesthesiology department chairs (n = 777) registered with the German Society of Anaesthesiology and Intensive Care Medicine. RESULTS: The general response rate was 31...
June 2016: Der Anaesthesist
Oskar Leander-Olsson, Anna Borglund-Hemph, Jan G Jakobsson
INTRODUCTION: Pneumothorax is a most rare intraoperative event but jeopardise safety. Risk factors for its occurrence should be acknowledged and it should be considered in cases of unexpected deterioration of oxygenation that not respond to standard management to improve oxygenation. PRESENTATION OF CASE: We describe a patient with mild obesity and recent shoulder trauma scheduled for elective arthroscopy under combined interscalene block and general anaesthesia in the beach chair position...
2016: International Journal of Surgery Case Reports
Juan A Juanes, Pablo Alonso, Felipe Hernández, Pablo Ruisoto, Clemente Muriel
INTRODUCTION: Regions considered optimal for performing peripheral nerve blocking have been well documented. However identify and perform regional anesthesia in those regions from ultrasound images remains a challenge. AIM: This study aims to develop a virtual environment for the simulation of ultrasound exploration of the neck nerves and both the upper and lower limbs for regional anesthesia. METHOD: Cross-sectional images were obtained from Magnetic Resonance Imaging for puncture regions involved in ultrasound-guided nerve block...
July 2016: Journal of Medical Systems
Giorgio Carlo Ginesu, M Puledda, C F Feo, M L Cossu, A Fancellu, F Addis, A Porcu
Neurilemmomas-or schwannomas-are rare soft tissue tumours involving peripheral nerve sheaths, usually found in the head and neck regions. They can infrequently originate within the tissues of the abdominal wall. Here, we present a case of symptomatic schwannoma of the abdominal wall in a 62-year-old woman referred for abdominal pain in the right iliac fossa. On physical examination, a 5-7-cm oval-shaped area of consolidation with regular borders and elastic consistence was palpable. Ultrasound examination of the abdomen revealed a hypoechogenic mass measuring 80-33-42 mm; subsequently, a CT scan confirmed the presence of a well-circumscribed mass, with small calcifications inside...
October 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Trine Dalsgaard Jensen, Luit Penninga
We report on a 21-year-old pregnant Greenlandic Inuit woman, who presented at a small local hospital in Northern Greenland. The patient suffered from lower abdominal pain, irregular bleeding and vomiting. urine-human chorionic gonadotropin (U-hCG) was positive. Ultrasonography showed the typical 'snow-storm' images of a mole pregnancy. Owing to the fact that local physicians were able to perform an ultrasound, proper diagnosis could be established, and the patient was transferred to the regional hospital, located nearly 1200 km away...
2016: BMJ Case Reports
S Munirama, R Eisma, M Columb, G A Corner, G A McLeod
BACKGROUND: We evaluated the physical properties and functional alignment of the soft-embalmed Thiel cadaver as follows: by assessing tissue visibility; by measuring its acoustic, mechanical and elastic properties; by evaluating its durability in response to repeated injection; and by aligning images with humans. METHODS: In four soft-embalmed Thiel cadavers, we conducted three independent studies. We assessed the following factors: (i) soft tissue visibility in a single cadaver for 28 weeks after embalming; (ii) the displacement of tissues in response to 1 and 5 ml interscalene and femoral nerve blocks in a single cadaver; and (iii) the stiffness of nerves and perineural tissue in two cadavers...
May 2016: British Journal of Anaesthesia
I M Ignat'ev
AIM: The study was aimed at improving the results of carotid endarterectomy (CEA) by means of improving technical methods of performing reconstruction of the carotid bifurcation. MATERIAL AND METHODS: From January 2012 to December 2014 at the Department of Vascular Surgery we performed a total of 703 CEA operations, including 183 (26%) according to the classical technique and 520 (74%) according to the eversion technique. The average age of patients amounted to 61...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
A Chuan, S Thillainathan, P L Graham, B Jolly, D M Wong, N Smith, M J Barrington
The Direct Observation of Procedural Skills (DOPS) form is used as a workplace-based assessment tool in the current Australian and New Zealand College of Anaesthetists curriculum. The objective of this study was to evaluate the reliability of DOPS when used to score trainees performing ultrasound-guided regional anaesthesia. Reliability of an assessment tool is defined as the reproducibility of scores given by different assessors viewing the same trainee. Forty-nine anaesthetists were recruited to score two scripted videos of trainees performing a popliteal sciatic nerve block and an axillary brachial plexus block...
March 2016: Anaesthesia and Intensive Care
Y Kuang, A Hilgers, M Sadiq, S Cochran, G Corner, Z Huang
Clear needle visualisation is recognised as an unmet need for ultrasound guided percutaneous needle procedures including regional anaesthesia and tissue biopsy. With inadequate needle visibility, these procedures may result in serious complications or a failed operation. This paper reports analysis of the modal behaviour of a previously proposed ultrasound-actuated needle configuration, which may overcome this problem by improving needle visibility in colour Doppler imaging. It uses a piezoelectric transducer to actuate longitudinal resonant modes in needles (outer diameter 0...
July 2016: Ultrasonics
S Heschl, B Hallmann, T Zilke, G Gemes, M Schoerghuber, M Auer-Grumbach, F Quehenberger, P Lirk, Q Hogan, M Rigaud
BACKGROUND: Peripheral nerve stimulation is commonly used for nerve localization in regional anaesthesia, but recommended stimulation currents of 0.3-0.5 mA do not reliably produce motor activity in the absence of intraneural needle placement. As this may be particularly true in patients with diabetic neuropathy, we examined the stimulation threshold in patients with and without diabetes. METHODS: Preoperative evaluation included a neurological exam and electroneurography...
April 2016: British Journal of Anaesthesia
A Chuan, Y C Lim, H Aneja, N A Duce, R Appleyard, K Forrest, C F Royse
The aim of this prospective, blinded, randomised controlled study was to compare novices' acquisition of the technical skills of ultrasound-guided regional anaesthesia using either a meat phantom model or fresh-frozen human cadavers. The primary outcome was the time taken to successfully perform an ultrasound-guided sciatic nerve block on a cadaver; secondary outcomes were the cumulative score of errors, and best image quality of the sciatic nerve achieved. After training, the median (IQR [range]) time taken to perform the block was 311(164-390 [68-600]) s in the meat model trained group and 210 (174-354 [85-600]) s in the fresh-frozen cadaver trained group (p = 0...
August 2016: Anaesthesia
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