Advancing the Science of Ultrasound Guided Regional Anesthesia and Pain Medicine


Ultrasound Improves Block Success

Positive Studies

  • Dufour E, Quennesson P, Van Robais AL, Ledon F, Laloe PA, Liu N, Fischler M: Combined ultrasound and neurostimulation guidance for popliteal sciatic nerve block: a prospective, randomized comparison with neurostimulation alone. Anesth Analg 2008;106:1553-8.
  • Kapral S, Greher M, Huber G, Willschke H, Kettner S, Kdolsky R, Marhofer P: Ultrasonographic guidance improves the success rate of interscalene brachial plexus blockade. Reg Anesth Pain Med 2008;33:253-8.
  • Perlas A, Brull R, Chan VW, McCartney CJ, Nuica A, Abbas S: Ultrasound guidance improves the success of sciatic nerve block at the popliteal fossa. Reg Anesth Pain Med 2008;33:259-65.
  • V W, Perlas A, McCartney C J, Brull R, Xu D, Abbas S. Ultrasound guidance improves success rate of axillary brachial plexus block. Can J Anaesth 2007;54: 176-182.
  • Dingemans E, Williams S R, Arcand G, Chouinard P, Harris P, Ruel M, Girard F. Neurostimulation in ultrasound-guided infraclavicular block: a prospective randomized trial. Anesth Analg 2007;104: 1275-80.
  • Domingo-Triado V, Selfa S, Martinez F, Sanchez-Contreras D, Reche M, Tecles J, Crespo M T, Palanca J M, Moro B. Ultrasound guidance for lateral midfemoral sciatic nerve block: a prospective, comparative, randomized study. Anesth Analg 2007;104: 1270-4.
  • Sites B D, Beach M L, Spence B C, Wiley C W, Shiffrin J, Hartman G S, Gallagher J D. Ultrasound guidance improves the success rate of a perivascular axillary plexus block. Acta Anaesthesiol Scand 2006;50: 678-684.
  • Soeding P E, Sha S, Royse C E, Marks P, Hoy G, Royse A G. A randomized trial of ultrasound-guided brachial plexus anaesthesia in upper limb surgery. Anaesth Intensive Care 2005; 33: 719-725.
  • Williams S R, Chouinard P, Arcand G, Harris P, Ruel M, Boudreault D, Girard F. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg 2003;97:1518-1523.

Negative Studies

  • Macaire P, Singelyn F, Narchi P, Paqueron X: Ultrasound- or nerve stimulation-guided wrist blocks for carpal tunnel release: a randomized prospective comparative study. Reg Anesth Pain Med 2008;33:363-8.
  • Sauter AR, Dodgson MS, Stubhaug A, Halstensen AM, Klaastad O: Electrical nerve stimulation or ultrasound guidance for lateral sagittal infraclavicular blocks: a randomized, controlled, observer-blinded, comparative study. Anesth Analg 2008; 106:1910-5.
  • Casati A, Danelli G, Baciarello M, Corradi M, Leone S, Di Cianni S, Fanelli G. A prospective, randomized comparison between ultrasound and nerve stimulation guidance for multiple injection axillary brachial plexus block. Anesthesiology 2007; 106:992-996.

Ultrasound Evaluation of Motor Response

  • Bloc S, Garnier T, Komly B, Asfazadourian H, Leclerc P, Mercadal L, Morel B, Dhonneur G. Spread of injectate associated with radial or median nerve-type motor response during infraclavicular brachial-plexus block: an ultrasound evaluation. Reg Anesth Pain Med 2007;32: 130-135.
  • Perlas A, Niazi A, McCartney C, Chan V, Xu D, Abbas S. The sensitivity of motor response to nerve stimulation and paresthesia for nerve localization as evaluated by ultrasound. Reg Anesth Pain Med 2006;31:445-450.

Ultrasound Improves Block Onset Time and Duration

  • Marhofer P, Schrogendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg 1997;85: 854-857.
  • Marhofer P, Sitzwohl C, Greher M, Kapral S. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia 2004;59:642-646.
  • Willschke H, Marhofer P, Bosenberg A, Johnston S, Wanzel O, Sitzwohl C, Kettner S, Kapral S. Epidural catheter placement in children: comparing a novel approach using ultrasound guidance and a standard loss-of-resistance technique. Br J Anaesth 2006;97:200-207.

Ultrasound Lowers Local Anesthetic Dose Requirement

  • Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJ: Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth 2008.
  • Casati A, Baciarello M, Di Cianni S, Danelli G, De Marco G, Leone S, Rossi M, Fanelli G. Effects of ultrasound guidance on the minimum effective anaesthetic volume required to block the femoral nerve. Br J Anaesth 2007;98:823-827.
  • Sandhu N S, Maharlouei B, Patel B, Erkulwater E, Medabalmi P. Simultaneous bilateral infraclavicular brachial plexus blocks with low-dose lidocaine using ultrasound guidance. Anesthesiology 2006;104:199-201.
  • Willschke H, Bosenberg A, Marhofer P, Johnston S, Kettner S, Eichenberger U, Wanzel O, Kapral S. Ultrasonographic-guided ilioinguinal/iliohypogastric nerve block in pediatric anesthesia: what is the optimal volume? Anesth Analg 2006; 102:1680-1684.
  • Sandhu N S, Bahniwal C S, Capan L M. Feasibility of an infraclavicular block with a reduced volume of lidocaine with sonographic guidance. J Ultrasound Med 2006;25: 51-56.
  • Willschke H, Marhofer P, Bosenberg A, Johnston S, Wanzel O, Cox S G, Sitzwohl C, Kapral S. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth 2005;95: 226-230.
  • Marhofer P, Schrogendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med 1998; 23:584-588.

Ultrasound Use in Difficult Situations

  • Duggan E, Brull R, Lai J, Abbas S: Ultrasound-guided brachial plexus block in a patient with multiple glomangiomatosis. Reg Anesth Pain Med 2008;33:70-3.
  • Khelemsky Y, Rosenblatt MA: Ultrasound-guided supraclavicular block in a patient anticoagulated with argatroban. Pain Pract 2008;8:152.
  • Robards CB, Iwata T, Somasundaram L, Xu D, Hadzic A: Ultrasound-guided interscalene brachial plexus block in a patient with a ventriculoperitoneal shunt. Reg Anesth Pain Med 2008;33:273-4.
  • Dhir S, Balasubramanian S, Ross D: Ultrasound-guided peripheral regional blockade in patients with Charcot-Marie-Tooth disease: a review of three cases. Can J Anaesth 2008;55:515-20.
  • Bigeleisen P E. Ultrasound-guided infraclavicular block in an anticoagulated and anesthetized patient. Anesth Analg 2007;104:1285-7.
  • Assmann N, McCartney C J, Tumber P S, Chan V W. Ultrasound guidance for brachial plexus localization and catheter insertion after complete forearm amputation. Reg Anesth Pain Med 2007;32:93.
  • • van Geffen G J, Scheuer M, Muller A, Garderniers J, Gielen M. Ultrasound-guided bilateral continuous sciatic nerve blocks with stimulating catheters for postoperative pain relief after bilateral lower limb amputations. Anaesthesia 2006; 61:1204-1207.
  • Plunkett A R, Brown D S, Rogers J M, Buckenmaier C C, III. Supraclavicular continuous peripheral nerve block in a wounded soldier: when ultrasound is the only option. Br J Anaesth 2006;97:715-717.
  • Minville V, Zetlaoui P J, Fessenmeyer C, Benhamou D. Ultrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease. Reg Anesth Pain Med 2004;29: 368-370.
  • Sites B D, Gallagher J, Sparks M. Ultrasound-guided popliteal block demonstrates an atypical motor response to nerve stimulation in 2 patients with diabetes mellitus. Reg Anesth Pain Med 2003;28:479-482.
  • Grau T, Leipold R W, Conradi R, Martin E. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand 2001;45:766-771.

Ultrasound Detects Intravascular Injection

Positive Report

  • VadeBoncouer TR, Weinberg GL, Oswald S, Angelov F: Early detection of intravascular injection during ultrasound-guided supraclavicular brachial plexus block. Reg Anesth Pain Med 2008;33: 278-9.

Negative Report

  • Zetlaoui PJ, Labbe JP, Benhamou D: Ultrasound guidance for axillary plexus block does not prevent intravascular injection. Anesthesiology 2008;108: 761.
  • Loubert C, Williams SR, Helie F, Arcand G: Complication during ultrasound-guided regional block: accidental intravascular injection of local anesthetic. Anesthesiology 2008;108:759-60.

Ultrasound Detects Intraneural Injection

  • Lee J, Lee YS: Percutaneous chemical nerve block with ultrasound-guided intraneural injection. Eur Radiol 2008;18:1506-12.
  • Chan V W, Brull R, McCartney C J, Xu D, Abbas S, Shannon P. An ultrasonographic and histological study of intraneural injection and electrical stimulation in pigs. Anesth Analg 2007;104:1281-4.
  • Brull R, Chan V W, McCartney C J, Perlas A, Xu D. Ultrasound detects intraneural injection. Anesthesiology 2007;106:1244.
  • Bigeleisen P E. Nerve puncture and apparent intraneural injection during ultrasound-guided axillary block does not invariably result in neurologic injury. Anesthesiology 2006; 105:779-783.
  • Schafhalter-Zoppoth I, Zeitz I D, Gray A T. Inadvertent femoral nerve impalement and intraneural injection visualized by ultrasound. Anesth Analg 2004;99:627-628.

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