Use of ultrasound for lower extremity

Abstract

Lower extremity blocks under ultrasound guidance often require advanced skills because of the depth of target nerves. This review summarizes the recent advances in the use of ultrasound guidance over traditional techniques.

Superior perioperative analgesia with combined femoral–obturator–sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery

“…Therefore, apart from complications that are expected in every peripheral nerve block, total spinal anaesthesia, epidural spread of the local anaesthetic, renal haematoma or pneumocele may happen with this block [1, 6, 8]. The use of ultrasound guidance could reduce the incidence of the complications mentioned above [10]. However, scanning of the lumbar plexus and directing the needle in real time under ultrasound guidance can be really challenging.…”

An update around the evidence base for the lower extremity ultrasound regional block technique

“…Sonoanatomical studies have shown that it is possible to visualize the transverse processes, vertebral body, psoas major muscle, erector spinae, quadratus lumborum, lower pole of the kidney, peritoneum, aorta, and vena cava 12 , 13 . As previously described, the continuous psoas compartment block can be performed under real-time ultrasound guidance using either a longitudinal or a transversal scan and an in-plane needle approach 1 . When a longitudinal scan is preferred, a curved array transducer is used to perform the first subcostal scan to localize the inferior kidney pole.…”

“…The second scan is dedicated to visualizing the sacral promontory in long axis as a sonoanatomical landmark, which allows one to ascend cranially to L2–L3, counting the shadows of the transverse processes 14 . A reliable catheterization of the lumbar plexus can be achieved after identifying the transverse processes of L2–L3 and the psoas muscle lying between them 1 . These sonoanatomical landmarks are always reproducible, whereas visualization of the lumbar nerve roots might be challenging with both transverse and longitudinal approaches.…”

“…The use of ultrasound applied to peripheral nerve blocks has been the object of several randomized controlled trials (RCTs) and reviews in the last two decades 1 – 3 . Despite the heterogeneity of RCTs comparing ultrasound guidance to other localization techniques in terms of type of block, anesthetic agents, and control groups, a recent systematic review published by Liu has shown a moderate superiority of ultrasound guidance for the majority of the evaluated block characteristics 2 .…”