Real-time three-dimensional ultrasound for continuous interscalene brachial plexus blockade

Abstract

Two-dimensional ultrasound guidance is used commonly for regional anesthetic techniques. This report describes the novel use of three-dimensional, ultrasound-guided, continuous interscalene regional analgesia, which was used in a 36-year-old woman undergoing left total elbow arthroplasty. Possible advantages of this novel technology over current two-dimensional methods include a larger area of available scan information that enables multiple planes of view without having to reposition the ultrasound probe, and three-dimensional visualization of local anesthetic deposition perineurally. Current technological limitations include an upper frequency of 7 MHz, which decreases the resolution of superficial scanning.

Three-dimensional ultrasound imaging

“…This technique is consequently not capable of steering a needle in real-time toward a target or observing real-time local anesthetic spread. In contrast, volume or matrix array transducers such as used by Clendenen et al [1] (X7-2 Matrix Array Probe, Philips Medical Systems, Bothell, Washington, USA) are equipped with more than 2400 piezoelectric elements and can receive and transmit data (Fig. 1).…”

“…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.…”

“…Artist's illustration of the beam generated by the X 7-2 matrix ultrasound probe (Philips Medical System) incorporated with the actual three-dimensional ultrasound image of the interscalene brachial plexus[1].…”

The new technological trends in ultrasound-guided regional anesthesia

“…After completing injection, the influence of arterial pulsation on the local anesthetic spread was visualized [22]. In other case reports, four-dimensional US has been used to observe local anesthetic distribution during the placement of a nerve block at the sciatic, and at interscalene level [23,24]. Authors used low-frequency transducers designed for pediatric heart echography that offers good temporal resolution but rendered difficult the high-quality identification of superficial nerves, surrounding structures and local anesthetic spread reconstructions.…”

From basic concepts to emerging technologies in regional anesthesia

“…In the past, three-dimensional image reconstruction of longitudinal and transverse planes required 20 min but this can now be achieved in real time. Recent reports describe the use of three-dimensional ultrasound to facilitate continuous interscalene and axillary brachial plexus blockade and popliteal catheter placement [27][28][29]. Current limitations of this technology include large probe size, which may limit its clinical application and an upper frequency limit of 7 MHz, which precludes high resolution superficial scanning [28 ].…”