Ultrasound Provides a Reliable Test of Local Anesthetic Spread

McCartney, Colin J. L.; Dickinson, Victoria M.; Dubrowski, Adam; Riazi, Sheila; McHardy, Paul; Awad, Imad T.

doi:10.1097/aap.0b013e3181e82e79

Cited by 10 publications

(3 citation statements)

References 14 publications

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“…USG has gained popularity in regional anesthesia as it is safe, reliable, and precise 6 . The sensitivity of ultrasound to guide administration of local anesthetic (LA) is ranged from 85% to 92%, and the specificity around 90% to 95% 7 . In developing countries like Mexico, due to the unavailability of resource, we continue to rely on the blind surface landmark technique.…”

Section: Discussionmentioning

confidence: 99%

Recurrent laryngeal nerve palsy after left-sided supraclavicular ultrasound-guided perivascular brachial plexus block. A unique case

Lira-Álvarez,

Barajas-Puga,

Gaeta-Valdez

et al. 2024

HGMX

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Supraclavicular brachial plexus nerve block is ideal for surgical procedures of the upper limb. Ultrasound guidance continues to grow in popularity as a method of nerve localization, significantly improves the quality of nerve block with a lesser number of complications, it has the advantage of allowing real-time visualization of the plexus, pleura, and vessels along with the needle and local anesthetic spread, although complications cannot be eliminated completely. Ipsilateral recurrent laryngeal nerve (RLN) palsy is a rare complication associated with supraclavicular approach. The incidence of the RLN block occurring with supraclavicular approach is 1.3% of patients, but incidence of block with ultrasound-guided supraclavicular block is not known. There are two cases reported in the world literature, in Mexico there is no evidence in this regard. We discuss the first case report in Mexico and the third in the world of this rare complication which occurred while performing a left supraclavicular perivascular block performed under ultrasound guidance.

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Section: Discussionmentioning

confidence: 99%

Recurrent laryngeal nerve palsy after left-sided supraclavicular ultrasound-guided perivascular brachial plexus block. A unique case

Lira-Álvarez,

Barajas-Puga,

Gaeta-Valdez

et al. 2024

HGMX

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“…Apart from BTX-A infiltration monitoring, the proposed method may be advantageous for other clinical applications, such as US guidance in regional anesthesia (Marhofer et al 2005;McCartney et al 2010;Andersen et al 2012;Sasaki et al 2017). Visual qualitative US guidance has been applied to monitor spread of local anesthetic, which allowed real-time identification of misdistributions of the anesthetic solution and guaranteed a faster onset time than the control groups.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Imaging of Injections in Masseter Muscle without Contrast Agent Using Strain Elastography and a Novel B-Mode Spatiotemporal Filter

Sanabria

Ruby

Kuonen

et al. 2020

Ultrasound in Medicine & Biology

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Botulinum toxin type A (BTX-A) injections in masseter muscle can alleviate muscle tightness and aching pain caused by idiopathic masticatory myalgia, a subform of the myofascial pain syndrome. Yet the injection procedure (number, amount) is currently empirical. In this ex vivo study, we determined the feasibility of using contrast-free ultrasound imaging to visualize the short-term injectate propagation. Ultrasound annotations of BTX-A injectate spread in N = 12 porcine masseter muscles were compared with the histopathology of the excised masseter. BTX-A presence was automatically detected in the ultrasound cine by: compensating tissue motion and deformation during injection with a novel spatiotemporal filtering (SF) algorithm, and by imaging tissue swelling strains with strain elastography (SE). BTX-A injectate introduced 6.5% (standard deviation = 5.0%) echogenicity contrast and 13.9% (standard deviation = 3.7%) tissue swelling strain. Muscle fasciae were a border for BTX-A distribution. The SF algorithm achieved significantly higher noise rejection (contrast-to-noise ratio = 4.63) than SE (2.56, p = 0.01), and state-of-the-art 2-D digital image correlation (1.81, p < 0.001) and direct image subtraction (1.29, p < 0.001) methods. Histopathology agreed well with ultrasound (Dice coefficient = 0.48), with deviations mainly explained by the three-dimensional inhomogeneous distribution of BTX-A. Preliminary in vivo patient results indicated that SF and SE discard artifactual BTX-A detection outside the injection region. The proposed methods contribute to objectivize ultrasound-guided injections, with additional applications, for instance, to monitor injectate spread of local anesthetics.

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“…Previous studies have demonstrated that ultrasound is a reliable method of detecting injectate spread in a gelatin phantom model [8]. It has also been shown that ultrasound-guided circumferential injection of local anesthetic around the sciatic nerve can improve the rate of sensory block [9].…”

Section: Discussionmentioning

confidence: 99%

A comparison of three techniques (local anesthetic deposited circumferential to vs. above vs. below the nerve) for ultrasound guided femoral nerve block

et al. 2014

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BackgroundFractured neck of femur generally requires operative fixation and is a common cause of admission to hospital. The combination of femoral nerve block and spinal anesthesia is a common anesthetic technique used to facilitate the surgical procedure. The optimal disposition of local anesthetic (LA) relative the femoral nerve (FN) has not been defined. Our hypothesis was: that the deposition of LA relative to the FN influences the quality of analgesia for positioning of the patient for performance of spinal anesthesia. The primary outcome was verbal rating (VRS) pain scores 0–10 assessed immediately after positioning the patient to perform spinal anesthesia.MethodsWith Institutional ethical approval and having obtained written informed consent from each, 52 patients were studied. The study was registered with ClinicalTrials.gov (NCT01527812). Patients were randomly allocated to undergo to one of three groups namely: intention to deposit lidocaine 2% (15 ml) i. above (Group A), ii. below (Group B), iii. circumferential (Group C) to the FN. A blinded observer assessed i. the sensory nerve block (cold) in the areas of the terminal branches of the FN and ii. VRS pain scores on passive movement from block completion at 5 minutes intervals for 30 minutes. Immediately after positioning the patient for spinal anesthesia, VRS pain scores were recorded.ResultsPain VRS scores during positioning were similar in the three groups [Above group/Below group/Circumferential group: 2(0–9)/0(0–10)/3(0–10), median(range), p:0.32]. The block was deemed to have failed in 20%, 47% and 12% in the Above group, Below group and Circumferential group respectively. The median number of needle passes was greater in the Circumferential group compared with the Above group (p:0.009). Patient satisfaction was greatest in the Circumferential group [mean satisfaction scores were 83.5(19.8)/88.1(20.5)/93.8(12.3), [mean(SD), p=0.04] in the Above, Below and Circumferential groups respectively.ConclusionsWe conclude that there is no clinical advantage to attempting to deposit LA circumferential to the femoral nerve (relative to depositing LA either above or below the nerve), during femoral nerve block in this setting.

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Ultrasound Provides a Reliable Test of Local Anesthetic Spread

Abstract: This study shows that ultrasound is a reliable method of detecting injectate spread in a gelatin phantom model.

Cited by 10 publications

References 14 publications

Recurrent laryngeal nerve palsy after left-sided supraclavicular ultrasound-guided perivascular brachial plexus block. A unique case

Recurrent laryngeal nerve palsy after left-sided supraclavicular ultrasound-guided perivascular brachial plexus block. A unique case

Ultrasound Imaging of Injections in Masseter Muscle without Contrast Agent Using Strain Elastography and a Novel B-Mode Spatiotemporal Filter

A comparison of three techniques (local anesthetic deposited circumferential to vs. above vs. below the nerve) for ultrasound guided femoral nerve block

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