Real-Time Three-Dimensional Ultrasound for Continuous Popliteal Blockade: A Case Report and Image Description

Feinglass, Neil G.; Clendenen, Steven R.; Torp, Klaus D.; Wang, R. Doris; Castelló, Ramón; Greengrass, Roy A.

doi:10.1213/01.ane.0000265439.02497.a7

Cited by 51 publications

(29 citation statements)

References 6 publications

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“…Part of the dilemma is appreciating a three dimensional phenomenon using a two dimensional imaging technique. Although there are reports of using three-dimensional ultrasound to improve visualization of the anatomy with these types of peripheral nerve blocks, it still has not reached mainstream application in clinical practice, nor has there been much focus on the dynamics of the local anesthetic during injection [7] .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound guidance showing real-time local anesthetic extravasation during injection of two lateral popliteal sciatic nerve blocks

Osman¹,

Missair

Weisman³

et al. 2013

JBGC

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Objective: The purpose of this case report is to describe an observation of local anesthetic extravasation while performing single-shot lateral sciatic popliteal blocks on two patients using ultrasound guided imaging. This under-reported phenomenon may have clinical implications and warrants further examination of conventional practice techniques. Case report:We performed lateral sciatic popliteal blocks under ultrasound guidance for post-operative pain in two patients having surgery in the left lower extremity. Both blocks involved sequential, real-time scans during the injection beneath the complex fascial sheath of the sciatic nerve. Observations included extrafascial extravasation of local anesthetic away from the nerve, up the needle path, and also concentrically outside the nerve sheath. Both blocks had 100% sensory block but slower clinical onset than expected. Conclusions:Ultrasound imaging is an evolving technology gaining popularity for performing peripheral nerve blocks. The incidence and volume of local anesthetic extravasation with single shot nerve blocks are unknown. This phenomenon may be common but frequently undetected given the limited resolution and the two-dimensional nature of current ultrasound imaging technology. The clinical consequences of local anesthetic injection into tissues outside of the nerve sheath are unknown, however our observations suggest speed of onset and quality of blocks may be affected. Further investigation evaluating the extravasation of local anesthetics during ultrasound blockade is needed to re-evaluate injection speeds and the use of conventional volumes for injection.

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Section: Discussionmentioning

confidence: 99%

Ultrasound guidance showing real-time local anesthetic extravasation during injection of two lateral popliteal sciatic nerve blocks

Osman¹,

Missair

Weisman³

et al. 2013

JBGC

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“…This enables the physician to see the needle's approach to the target nerve within the field of view. In addition, to help improve therapeutic accuracy of ultrasound-guided pain medicine, the ultrasound characteristics of needles have been described (Maecken et al, 2007), "echo-friendly" needle designs have been developed (Deam, 2007), and the benefits of three-dimensional (3D) ultrasound imaging has been investigated (Feinglass et al, 2007;Foxall, et al, 2007). Moreover, cutting edge ultrasonic technological advances have introduced image-enhanced tissue staining to remotely palpate the target nerve of interest using acoustic radiation force imaging to both improve accuracy and limit variability in regional anesthesia (Palmeri et al, 2008;Nightingale et al, 2001).…”

Section: Ultrasound Guidance In Pain Medicine: Regional Anesthesiamentioning

confidence: 99%

Applied Radiologic Science in the Treatment of Pain: Interventional Pain Medicine

Wininger¹

2012

Pain Management - Current Issues and Opinions

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“…Although the picture quality during real time volumetric imaging makes demonstration of nerves difficult, improvements in resolution are awaited, which could to distinguish neural structures better. However, live volumetric imaging has already been used to place a popliteal sciatic nerve catheter successfully [12].…”

Section: ó 2010 the Authormentioning

confidence: 99%

“…However, the use of three-dimensional ultrasound imaging has been described during vascular access [10] and it has been used to demonstrate nerves and perform spatial mapping of the brachial plexus [11]. Four-dimensional ultrasound (live or real time three-dimensional described below) has facilitated successful placement of a popliteal catheter [12] and aided needle-guidance during performance of a peripheral radial nerve block [13].…”

mentioning

confidence: 99%

New technologies in nerve location

Bedforth¹

2010

Anaesthesia

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Summary Regional anaesthesia is undergoing a renaissance, perhaps assisted by the introduction of (and enthusiasm for) ultrasound‐guided regional anaesthesia into clinical practice. This article summarises the technology and principles of ultrasound imaging in anaesthesia and describes the development of three‐dimensional ultrasound imaging, considering whether this new technology has an application in regional anaesthesia.

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Real-Time Three-Dimensional Ultrasound for Continuous Popliteal Blockade: A Case Report and Image Description

Cited by 51 publications

References 6 publications

Ultrasound guidance showing real-time local anesthetic extravasation during injection of two lateral popliteal sciatic nerve blocks

Ultrasound guidance showing real-time local anesthetic extravasation during injection of two lateral popliteal sciatic nerve blocks

Applied Radiologic Science in the Treatment of Pain: Interventional Pain Medicine

New technologies in nerve location

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