Ultrasound in regional anaesthesia

Abstract

Ultrasound guidance is rapidly becoming the gold standard for regional anaesthesia. There is an ever growing weight of evidence, matched with improving technology, to show that the use of ultrasound has significant benefits over conventional techniques, such as nerve stimulation and loss of resistance. The improved safety and efficacy that ultrasound brings to regional anaesthesia will help promote its use and realise the benefits that regional anaesthesia has over general anaesthesia, such as decreased morbidity and mortality, superior postoperative analgesia, cost-effectiveness, decreased postoperative complications and an improved postoperative course. In this review we consider the evidence behind the improved safety and efficacy of ultrasound-guided regional anaesthesia, before discussing its use in pain medicine, paediatrics and in the facilitation of neuraxial blockade. The Achilles' heel of ultrasound-guided regional anaesthesia is that anaesthetists are far more familiar with providing general anaesthesia, which in most cases requires skills that are achieved faster and more reliably. To this ends we go on to provide practical advice on ultrasound-guided techniques and the introduction of ultrasound into a department.

Large retroperitoneal haematoma: an unexpected complication of ilioinguinal nerve block for inguinal hernia repair

“…Over 3000 patients have been exposed to this drug and we have found 30 patients to date (approximately 1%) who have experienced severe anaphylaxis with cardiovascular collapse; this is similar to the 0.86% incidence from the ALMANAC and NEW START datasets [5]. The incidence of anaphylactic reactions during anaesthesia is estimated at between 1 in 3500 and 1 in 13000 [6]; with neuromuscular blocking drugs responsible for roughly 60% of reactions, followed by exposure to latex and antibiotics at around 15% each [7]. Our 1% rate of reaction therefore potentially makes Patent Blue V the most common drug causing severe anaphylaxis in the operating theatre environment.…”

Incidental detection of bowel herniation with ultrasonography and fluoroscopy during a caudal block

“…1,2 With an expanding role for ultrasonography-guided techniques for chronic pain therapy, there is an ever-increasing potential to identify incidental but potentially important non-neural pathologies. We describe a case wherein ultrasonography in conjunction with fluoroscopy led to the incidental discovery of a bowel herniation in a patient undergoing a caudal block.…”

Ultrasound guided supraclavicular brachial plexus block using plain ropivacaine and ropivacaine with adjuvants

“…Improved perioperative outcomes coupled with increased patient satisfaction, as well as minimal alteration in homeostasis are some of the reasons for the growing popularity of this field. 1 Inclusion of additives (opioids or non-opioids) with local anaesthetics in brachial plexus block is aimed at quicker onset, enhanced quality and duration of blockade. Popular additives being used are clonidine, dexmedetomidine, buprenorphine, morphine, fentanyl and midazolam.…”