Real-Time 3-Dimensional Ultrasound-Assisted Infraclavicular Brachial Plexus Catheter Placement: Implications of a New Technology

Abstract

Background. There are a variety of techniques for targeting placement of an infraclavicular blockade; these include eliciting paresthesias, nerve stimulation, and 2-dimensional (2D) ultrasound (US) guidance. Current 2D US allows direct visualization of a “flat” image of the advancing needle and neurovascular structures but without the ability to extensively analyze multidimensional data and allow for real-time manipulation. Three-dimensional (3D) ultrasonography has gained popularity and usefulness in many clinical specialties such as obstetrics and cardiology. We describe some of the potential clinical applications of 3D US in regional anesthesia. Methods. This case represents an infraclavicular catheter placement facilitated by 3D US, which demonstrates 360-degree spatial relationships of the entire anatomic region. Results. The block needle, peripheral nerve catheter, and local anesthetic diffusion were observed in multiple planes of view without manipulation of the US probe. Conclusion. Advantages of 3D US may include the ability to confirm correct needle and catheter placement prior to the injection of local anesthetic. The spread of local anesthetic along the length of the nerve can be easily observed while manipulating the 3D images in real-time by simply rotating the trackball on the US machine to provide additional information that cannot be identified with 2D US alone.

Improving needle tip identification during ultrasound-guided procedures in anaesthetic practice

“…). Matrix array probes have been used in axillary plexus block , catheter placement at the popliteal nerve , interscalene and infraclavicular brachial plexus blocks . Even a transoesophageal 3D matrix array probe, providing an anterior view of the spinal cord, can guide placement of an epidural catheter .…”

Ultrasound-Guided Continuous Interscalene Block

“…21 In the future, new 3-dimensional or GPS-type tracking system US probes should improve both catheter tip positioning and understanding of their pathway. 22 Furthermore, perineural local anesthetic delivery method could have an impact on possible development of tolerance. Tachyphylaxis to local anesthetics, defined as a decrease in duration or intensity of nerve blockade despite repeated identical boluses, has been described in animal studies and involves both pharmacokinetic and pharmacodynamic mechanisms.…”

Three-dimensional ultrasound imaging

“…In 2007, they described placement of sciatic popliteal catheter assisted by realtime 3-D ultrasound. Subsequently, the same group published on utilization of this technology for a variety of other nerve blocks, including axillary plexus block and interscalene and infraclavicular brachial plexus catheter placement [1,9,10]. One of the advantages observed with their utilized equipment (3D Ultrasound System IE-33/IU 22; Philips Medical Systems, Andover, Massachusetts, USA) was the ability to manipulate the image and visualize different planes without the need to reposition the ultrasound probe.…”