Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review

Abstract

Nerve stimulation and ultrasound have been introduced to the practice of regional anesthesia mostly in the last two decades. Ultrasound did not gain as much popularity as the nerve stimulation until a decade ago because of the simplicity, accuracy and portability of the nerve stimulator. Ultrasound is now available in most academic centers practicing regional anesthesia and is a popular tool amongst trainees for performance of nerve blocks. This review article specifically discusses the role of ultrasonography for deeply situated nerves or plexuses such as the infraclavicular block for the upper extremity and lumbar plexus and sciatic nerve blocks for the lower extremity. Transitioning from nerve stimulation to ultrasound-guided blocks alone or in combination is beneficial in certain scenarios. However, not every patient undergoing regional anesthesia technique benefits from the use of ultrasound, especially when circumstances resulting in difficult visualization such as deep nerve blocks and/or block performed by inexperienced ultrasonographers. The use of ultrasound does not replace experience and knowledge of relevant anatomy, especially for visualization of deep structures. In certain scenarios, ultrasound may not offer additional value and substantial amount of time may be spent trying to find relevant structures or even provide a false sense of security, especially to an inexperienced operator. We look at available literature on the role of ultrasound for the performance of deep peripheral nerve blocks and its benefits.

Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

“…Deep regional blocks have been used for years to provide perioperative anesthesia for surgery and postoperative pain control [ 1 ]. In the management of patients with chronic pain, such as those with complex regional pain syndrome (CRPS) and postherpetic neuralgia, deep regional blocks, for example, stellate ganglion blocks (SGBs), serve as an alternative to other medical treatments.…”

Regional analgesia in cardiothoracic surgery: A changing paradigm toward opioid-free anesthesia?

“…Performing nerve blocks with ultrasound guidance not only reduces the rate of complications (vascular or nerve injury and intravascular injection) but also upsurges the success rate of the nerve block, that too with smaller quantity of local anesthetic solutions. [ 4 ] Nerve blocks for limbs are simpler, but the chest innervation and block is complicated. There are multiple plexuses, and nerves that are embedded in muscular fascial planes innervating the chest wall, which make blocking them difficult.…”

Ultrasonography-guided transplantation facilitates perineural delivery of stem cells

“…However, application to the peripheral nerve is limited, although ultrasonography-guided nerve stimulation is frequently used for regional anesthesia (Wadhwa et al 2011). Recently, ultrasonography-guided injection has facilitated the safe delivery into the perineural region (Belavy et al 2013), demonstrating the safety of ultrasonography gels and needle injection.…”