Ultrasound‐guided technique allowed early detection of intravascular injection during an infraclavicular brachial plexus block

Navas, A. Martínez; González, R. Ortiz de la Tabla

doi:10.1111/j.1399-6576.2009.01981.x

Cited by 15 publications

(2 citation statements)

References 19 publications

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“…83 In addition, ultrasound guidance is not immune to limitations of stimulation-based techniques, including intraneural and intravascular injection. 85,86 As a result of the dramatic shift toward direct ultrasound visualization, the focus and quantity of research devoted to nerve stimulation will likely diminish. However, numerous undeveloped and/or controversial issues remain and would benefit from further study.…”

Section: Future Directionsmentioning

confidence: 99%

Peripheral Nerve Stimulation in Regional Anesthesia

Klein¹,

Melton

Grill

et al. 2012

Regional Anesthesia and Pain Medicine

103

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Peripheral nerve stimulation has a long history in regional anesthesia. Despite the advent of ultrasound-guided peripheral nerve blockade, nerve stimulation remains a popular technique used alone or, now, in combination with ultrasound-guided techniques. In light of this evolving utility of nerve stimulation, this is an appropriate time to review the basic concepts and knowledge base of this historically important tool. Electrical nerve stimulation facilitates nerve localization, using threshold current as a surrogate for needle-to-nerve distance. Preferential activation of motor nerves is possible because motor nerve fibers are more readily activated with a shorter duration of current compared with sensory nerves. The association between current and needle-to-nerve distance predicts that less current is needed to evoke a motor response as the needle moves closer to the nerve. Thus, an elicited motor response at or below 0.5 mA is considered a common end point for successful neural blockade. However, current magnitude is neither 100% sensitive nor specific. Independent of technical ability, both the biological environment and the equipment used impact the current-distance relationship. Thus, successful electrical nerve stimulation is dependent on an anesthesiologist with a solid foundation in anatomy and a thorough understanding of electrophysiology.

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Section: Future Directionsmentioning

confidence: 99%

Peripheral Nerve Stimulation in Regional Anesthesia

Klein¹,

Melton

Grill

et al. 2012

Regional Anesthesia and Pain Medicine

103

View full text Add to dashboard Cite

show abstract

“…In terms of complication avoidance, some case reports have demonstrated that the pressure applied with the ultrasound probe in the infraclavicular area can collapse blood vessels and lead to a negative aspiration test, even when needle position is actually intravascular [39]. …”

Section: Evidence Of Use Of Ultrasonography For Deep Nerve Blocksmentioning

confidence: 99%

Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review

Wadhwa

Kandadai

Tongpresert

et al. 2011

Anesthesiology Research and Practice

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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.

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Monitoring for Regional Anesthesia

Gadsden

2011

Essentials of Regional Anesthesia

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Ultrasound‐guided technique allowed early detection of intravascular injection during an infraclavicular brachial plexus block

Cited by 15 publications

References 19 publications

Peripheral Nerve Stimulation in Regional Anesthesia

Peripheral Nerve Stimulation in Regional Anesthesia

Ultrasound Guidance for Deep Peripheral Nerve Blocks: A Brief Review

Monitoring for Regional Anesthesia

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