scholarly journals A sono-anatomical and cadaveric study of ultrasound-guided retrolaminar block

2021 ◽  
Author(s):  
Fahd Aamir ◽  
Michael Cronin ◽  
Peter Lee ◽  
Gabriella Iohom ◽  
George Shorten
Keyword(s):  
Single Injection ◽  
Primary Objective ◽  
Poor Correlation ◽  
Injection Technique ◽  
Ultrasound Images ◽  
Ultrasound Guided ◽  
Paravertebral Space ◽  
Anatomical Dissection ◽  
Dynamic Ultrasound ◽  
Dye Staining

Aim: Retrolaminar block (RB) is known to confer chest wall analgesia but, its mechanism has not been established. Our primary objective was to determine if the spread of injectate following RB extends to the paravertebral space (PVS). Second-ary objectives were to determine the predefined anatomical areas and nervous tissues contacted by injectate; the effect of volume on spread; and the extent to which experts can predict PVS spread based on examination of US videos of the injection. Material and methods: US-guided RB was performed on cadavers using a single injection technique of 10, 20 or 30 ml dye. Anatomical dissection was performed to identify the extent of spread of injectate to the retrolaminar, intercostal and PVS. Ultrasound recordings of the injection were independently evaluated by experts in US-guided regional anaesthesia. Results: Spread of injectate to the ipsilateral PVS was identified in 6/10 dissected regions (0/1, 1/3 and 5/6 when injectate volumes of 10, 20 and 30ml were administered respectively). The extent of cephalad-caudad spread within the PVS varied from 1 to 3 levels. Expert interpretation of ultrasound images regarding spread to the PVS demonstrated poor correlation with dye staining observed on dissection. Conclusions: Injectate spread following RB demonstrated substantial variability. Inconsistent spread to the ipsilateral PVS may account for clinically occurring incomplete blocks. The likelihood of spread to the ipsilateral PVS was greater when a larger volume was injected. Expert evaluation of the dynamic ultrasound images obtained at injection can-not reliably predict spread to the PVS.

Single- versus double-injection costoclavicular block: a randomized comparison

2020 ◽  
Vol 45 (3) ◽  
pp. 209-213 ◽  
Author(s):  
Sebastián Layera ◽  
Julián Aliste ◽  
Daniela Bravo ◽  
Diego Fernández ◽  
Armando García ◽  
...  
Keyword(s):  
Brachial Plexus ◽  
Local Anesthetic ◽  
Single Injection ◽  
Onset Time ◽  
Injection Technique ◽  
Ultrasound Guided ◽  
Double Injection ◽  
Performance Time ◽  
Injection Group ◽  
Upper Limb Surgery

BackgroundThe costoclavicular approach targets the brachial plexus in the proximal infraclavicular fossa, where the lateral, medial, and posterior cords are tightly bundled together. This randomized trial compared single- and double-injection ultrasound-guided costoclavicular blocks. We selected onset time as the primary outcome and hypothesized that, compared with its single-injection counterpart, the double-injection technique would result in a swifter onset.MethodsNinety patients undergoing upper limb surgery (at or below the elbow joint) were randomly allocated to receive a single- (n=45) or double-injection (n=45) ultrasound-guided costoclavicular block. The local anesthetic agent (35 mL of lidocaine 1%-bupivacaine 0.25%with epinephrine 5 µg/mL and 2 mg of preservative-free dexamethasone) was identical in all subjects. In the single-injection group, the entire volume of local anesthetic was injected between the three cords of the brachial plexus. In the double-injection group, the first half of the volume was administered in this location; the second half was deposited between the medial cord and the subclavian artery. After the performance of the block, a blinded observer recorded the onset time (defined as the time required to achieve a minimal sensorimotor composite score of 14 out of 16 points), success rate (surgical anesthesia) and block-related pain scores. Performance time and the number of needle passes were also recorded during the performance of the block. The total anesthesia-related time was defined as the sum of the performance and onset times.ResultsCompared with its single-injection counterpart, the double-injection technique displayed shorter onset time (16.6 (6.4) vs 23.4 (6.9) min; p<0.001; 95% CI for difference 3.9 to 9.7) and total anesthesia-related time (22.5 (6.7) vs 28.9 (7.6) min; p<0.001). No intergroup differences were found in terms of success and technical execution (ie, performance time/procedural pain). The double-injection group required more needle passes than the single-injection group (2 (1–4) vs 1 (1–3); p<0.001).ConclusionCompared with its single-injection counterpart, double-injection costoclavicular block results in shorter onset and total anesthesia-related times. Further investigation is required to determine if a triple-injection technique (with targeted local anesthetic injection around each cord of the brachial plexus) could further decrease the onset time.Trial registration numberNCT03595514.

Thoracic-paravertebral blocks: comparative anatomical study with different injection techniques and volumes

2019 ◽  
pp. rapm-2019-100896 ◽  
Author(s):  
Ronald Seidel ◽  
Andreas Wree ◽  
Marko Schulze
Keyword(s):  
Epidural Space ◽  
Anatomical Study ◽  
Sympathetic Trunk ◽  
Injection Technique ◽  
Initial Contact ◽  
Ultrasound Guided ◽  
Paravertebral Space ◽  
Injection Volume ◽  
Injection Techniques ◽  
Intercostal Nerves

Background and objectivesWe hypothesized that different injection techniques and volumes in thoracic-paravertebral blocks (TPVB) lead to different patterns of dye spread. In particular, we investigated whether an alternating injection technique leads to complete staining of all adjacent intercostal nerves.MethodsThis comparative anatomical investigation was performed using 10 or 20 mL of dye (Alcian Blue) in 10 unfixed donor cadavers (54 injections) that were designated for education or research purposes.ResultsIn landmark-guided TPVB, the thoracic-paravertebral space (TPVS) was either not stained at all (spread of dye in the paraspinal muscles, n=3) or the dye was predominantly found in the epidural space (n=3). In ultrasound-guided TPVB, the TPVS was correctly identified in all cases (n=48). The sympathetic trunk was stained in 84.6% of injections (multi-injection technique: 100%), independent of injection technique and volume. The epidural space was stained more frequently (p≤0.001) if both the puncture site (sagittal transducer position) and guidance of the needle were more medial (77.8%). Finally, a higher injection volume (20 vs 10 mL) resulted in a higher number of stained intercostal nerves (p=0.04).ConclusionFor ultrasound-guided techniques, a higher injection volume resulted in a larger number of stained intercostal nerves. Staining of the sympathetic trunk was independent of the injection technique. Epidural spread was observed significantly less frequently if the injection was lateral (transducer transversal) or with a strictly cranial injection direction (transducer sagittal). Landmark-guided injections reliably achieved the TPVS (and the epidural space) only after a needle advance of 2.5 cm after initial contact with the transverse process.

Single-Injection Versus Multiple-Injection Technique of Ultrasound-Guided Paravertebral Blocks

2017 ◽  
Vol 42 (5) ◽  
pp. 575-581 ◽  
Author(s):  
Vishal Uppal ◽  
Rakesh V. Sondekoppam ◽  
Parvinder Sodhi ◽  
David Johnston ◽  
Sugantha Ganapathy
Keyword(s):  
Single Injection ◽  
Injection Technique ◽  
Multiple Injection ◽  
Ultrasound Guided

Different Approaches to Ultrasound-guided Thoracic Paravertebral Block

2015 ◽  
Vol 123 (2) ◽  
pp. 459-474 ◽  
Author(s):  
Annelot C. Krediet ◽  
Nizar Moayeri ◽  
Geert-Jan van Geffen ◽  
Jörgen Bruhn ◽  
Steven Renes ◽  
...  
Keyword(s):  
Cross Sections ◽  
Ultrasound Guidance ◽  
Ultrasound Images ◽  
Ultrasound Guided ◽  
Paravertebral Space ◽  
Cross Sectional ◽  
Comprehensive Information ◽  
Anatomical Images ◽  
Human Specimen ◽  
Fast Development

Abstract Given the fast development and increasing clinical relevance of ultrasound guidance for thoracic paravertebral blockade, this review article strives (1) to provide comprehensive information on thoracic paravertebral space anatomy, tailored to the needs of a regional anesthesia practitioner, (2) to interpret ultrasound images of the thoracic paravertebral space using cross-sectional anatomical images that are matched in location and plane, and (3) to briefly describe and discuss different ultrasound-guided approaches to thoracic paravertebral blockade. To illustrate the pertinent anatomy, high-resolution photographs of anatomical cross-sections are used. By using voxel anatomy, it is possible to visualize the needle pathway of different approaches in the same human specimen. This offers a unique presentation of this complex anatomical region and is inherently more realistic than anatomical drawings.

scholarly journals Reducing Patient Discomfort during Digital Blockade: The Subcutaneous Single Injection Digital Block – A Simple, Safe and Fast Procedure

2003 ◽  
Vol 11 (1) ◽  
pp. 33-35 ◽  
Author(s):  
JP Brutus ◽  
A Nikolis ◽  
Y Baeten ◽  
N Chahidi ◽  
L Kinnen ◽  
...  
Keyword(s):  
Single Injection ◽  
Proximal Phalanx ◽  
Injection Technique ◽  
Dorsal Aspect ◽  
Single Finger ◽  
Volar Aspect ◽  
Tolerance Distribution ◽  
A Prospective Study ◽  
Fast Procedure ◽  
Digital Block

Background Regional anesthesia of a single finger is commonly achieved by the traditional ring block, which requires at least two painful injections in the digit. Single injection digital block techniques have been described to avoid this problem. Among these, the subcutaneous technique described by Harbison appears to be safe and to allow most procedures to be carried out with good tolerance. Objectives A prospective study was designed to evaluate the results of the subcutaneous technique in terms of patient tolerance, distribution of anesthesia and efficiency. Methods All blocks were performed by a single investigator. A visual analog scale was used to evaluate pain associated with the injection. Prick testing was used to evaluate the quality of anesthesia at the volar and dorsal aspects of the phalanxes. Tolerance to the surgical procedure and the need for additional injections were also recorded. Results This technique allowed surgery to be performed without complementary injection most of the time and was very well tolerated. The dorsum of the proximal phalanx, however, was unpredictably included in the anesthetized territory. Conclusion The subcutaneous single injection digital block is safe, efficient and easy to perform. It allows the treatment of all conditions on the volar aspect of the finger and on the dorsal aspect of the distal and middle phalanxes. For surgery on the dorsal aspect of the proximal phalanx, a combined single injection technique or a supplementary dorsal block should be used.

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