Ultrasound-guided peripheral regional anesthesia : Placement and dosage of local anesthetics.
Summary of "Ultrasound-guided peripheral regional anesthesia : Placement and dosage of local anesthetics."
Ever since the use of ultrasound guidance in regional anesthesia became more and more popular in recent years, it seemed obvious that so-called intraneural puncture and injection of local anesthetics was much more common than previously assumed. However, neurologic damage was not seen very often. The ultrasound-guided imaging of the nerves showed that intraneural injection has to be seen as an overall term. This term must be characterized in more detail in accordance with nerve anatomy and morphology. Various studies demonstrated that if intraneural puncture occured the needle usually took a path away from the fascicles (intraneural perifascicular), while intraneural transfascicular puncture seemed relatively rare and intraneural intrafascicular placement of the needle even more uncommon. As long as the needle is placed intraneurally but in an extrafascicular fashion a safe injection and the absence of neurologic damage can be assumed. However, if nerve fascicles are affected neurologic dysfunction can occur. In studies investigating the minimal effective local anesthetic volume needed for successful nerve block, a relevant reduction of injected volume was still achieved by intentionally applying the local anesthetic circumferentially around the outermost nerve layer rather than injecting it into neural structures. As an intraneural -intrafascicular injection carries the risk of nerve injury associated with a decrease in quality of life, the potential of ultrasound guidance in regional anesthesia should be considered. Circumferential administration of local anesthetic rather than creating a single point injection appears to be advantageous.
Affiliation
Klinik für Anästhesiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland, gernot.gorsewski@uniklinik-ulm.de.
Journal Details
This article was published in the following journal.
Name: Der Anaesthesist
ISSN: 1432-055X
Pages:
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/22790475
- DOI: http://dx.doi.org/10.1007/s00101-012-2045-x
Medical and Biotech [MESH] Definitions
Dibucaine
A local anesthetic of the amide type now generally used for surface anesthesia. It is one of the most potent and toxic of the long-acting local anesthetics and its parenteral use is restricted to spinal anesthesia. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1006)
Procaine
A local anesthetic of the ester type that has a slow onset and a short duration of action. It is mainly used for infiltration anesthesia, peripheral nerve block, and spinal block. (From Martindale, The Extra Pharmacopoeia, 30th ed, p1016).
Cordocentesis
The collecting of fetal blood samples via ultrasound-guided needle aspiration of the blood in the umbilical vein.
Administration, Sublingual
Administration of a soluble dosage form by placement under the tongue.
Surgery, Computer-assisted
Surgical procedures conducted with the aid of computers. This is most frequently used in orthopedic and laparoscopic surgery for implant placement and instrument guidance. Image-guided surgery interactively combines prior CT scans or MRI images with real-time video.
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