Diferencia entre revisiones de «Ultrasound: Nerves»

Sin resumen de edición
Sin resumen de edición
Línea 1: Línea 1:
==Background==
==Background==
Regional nerve block reduces the need for pain control medications, sedation and procedural sedation. When applying to emergency department setting it contributed to decreased length of ED stay, post-procedural observation period and also improve patient's satisfaction. <ref>Wilson JE. et al. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989 Nov;7(6):620-3.</ref><ref>McQuay HJ. et al. Postoperative orthopaedic pain-the effect of opiate premedication and local anaesthetic blocks.Pain. 1988 Jun;33(3):291-5.</ref><ref>Liebmann O. et al.Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006 Nov;48(5):558-62.</ref><ref>Stone MB. et  al.Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. Am J Emerg Med. 2008 Jul;26(6):706-10.</ref><ref>Blaivas M et al.Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED.Am J Emerg Med. 2006 May;24(3):293-6.</ref><ref>Beaudoin FL. et al.Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures.Am J Emerg Med. 2010 Jan;28(1):76-81.</ref> Newer ultrasound technology that comes with high-resolution image made ultrasound-guided nerve block, either alone or in combination with other methods to localise the nerve become more favourable due to more success rate comparing to the use of other methods alone. This technique can be utilised for both regional and peripheral nerve block. <ref>Lewis SR. et al. Ultrasound guidance for upper and lower limb blocks.Cochrane Database Syst Rev. 2015 Sep 11;(9)</ref><ref>Walker KJ. et al. Ultrasound guidance for peripheral nerve blockade.Cochrane Database Syst Rev. 2009 Oct 7;(4)</ref><ref>Neal JM. et al. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: Executive summary.Reg Anesth Pain Med. 2010 Mar-Apr;35(2 Suppl):S1-9</ref>Ultrasound allow dynamic visualisation of target nerves, needed tip and anaesthetic agent while being infused. This minimise the complications that could occurred form nerve blocks.  
Regional nerve block reduces the need for pain control medications, sedation and procedural sedation. When applying to emergency department setting it contributed to decreased length of ED stay, post-procedural observation period and also improve patient's satisfaction. <ref>Wilson JE. et al. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989 Nov;7(6):620-3.</ref><ref>McQuay HJ. et al. Postoperative orthopaedic pain-the effect of opiate premedication and local anaesthetic blocks.Pain. 1988 Jun;33(3):291-5.</ref><ref>Liebmann O. et al.Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006 Nov;48(5):558-62.</ref><ref>Stone MB. et  al.Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. Am J Emerg Med. 2008 Jul;26(6):706-10.</ref><ref>Blaivas M et al.Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED.Am J Emerg Med. 2006 May;24(3):293-6.</ref><ref>Beaudoin FL. et al.Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures.Am J Emerg Med. 2010 Jan;28(1):76-81.</ref> Newer ultrasound technology that comes with high-resolution image made ultrasound-guided nerve block, either alone or in combination with other methods to localise the nerve become more favourable due to more success rate comparing to the use of other methods alone. This technique can be utilised for both regional and peripheral nerve block. <ref>Lewis SR. et al. Ultrasound guidance for upper and lower limb blocks.Cochrane Database Syst Rev. 2015 Sep 11;(9)</ref><ref>Walker KJ. et al. Ultrasound guidance for peripheral nerve blockade.Cochrane Database Syst Rev. 2009 Oct 7;(4)</ref><ref>Neal JM. et al. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: Executive summary.Reg Anesth Pain Med. 2010 Mar-Apr;35(2 Suppl):S1-9</ref>Ultrasound allow dynamic visualisation of target nerves, needed tip and anaesthetic agent while being injected. This minimise the complications that could occurred form nerve blocks.  


==Indications==
==Indications==
Línea 9: Línea 9:
*Analgesia especially for major pain, i.e. multiple ribs fractures, flail chest and femoral fracture.  
*Analgesia especially for major pain, i.e. multiple ribs fractures, flail chest and femoral fracture.  


==Technique==
==Knobology==  
*Knobology
*A linear array probe is required
**A linear array probe is required
*Adjust frequency to the highest setting (optimal frequency is 12-18 MHz). Adjust according to patient habits, i.e. lower the frequent if the patient is obese.  
*Preparation
*It is easier to identify the nerve in short axis and work in transverse plane.
**Adjust frequency to the highest setting (optimal frequency is 12-18 MHz). Adjust according to patient habits, i.e. lower the frequent if the patient is obese.  
*Hold the probe with indicator to your left.  
**It is easier to identify the nerve in short axis and work in transverse plane.
**Hold the probe with indicator to your left.
**Forearm nerve block superficial cervical plexus block and supraclavicular brachial plexus block are semi-sterile procedures. Femoral nerve block is a sterile procedure.
**Essential: sterile probe covers, gloves, gel and antiseptic. Needle gauge and length selection depend on the type of block.  


==Findings==
==Preparation==
*Forearm nerve block superficial cervical plexus block and supraclavicular brachial plexus block are semi-sterile procedures. Femoral nerve block is a sterile procedure.
*Essential: sterile probe covers, gloves, gel and antiseptic. Needle gauge and length selection depend on the type of block. A longer, 3.5 inches spinal needle may be an option for femoral blocks. Non-Cutting tip needed, for example Whitacre pencil point may reduce nerve injury.
*Consider attach a short extension tube to the needle for femoral nerve block if you have assistant or extra hands that can help with aspiration and injection while you are handling the needle.


==Identifying the nerves==


==Technique==
==Images==
==Images==
===Normal===
===Normal===

Revisión del 22:20 21 dic 2016

Background

Regional nerve block reduces the need for pain control medications, sedation and procedural sedation. When applying to emergency department setting it contributed to decreased length of ED stay, post-procedural observation period and also improve patient's satisfaction. [1][2][3][4][5][6] Newer ultrasound technology that comes with high-resolution image made ultrasound-guided nerve block, either alone or in combination with other methods to localise the nerve become more favourable due to more success rate comparing to the use of other methods alone. This technique can be utilised for both regional and peripheral nerve block. [7][8][9]Ultrasound allow dynamic visualisation of target nerves, needed tip and anaesthetic agent while being injected. This minimise the complications that could occurred form nerve blocks.

Indications

  • Anaesthesia for procedures commonly performed in the ED
    • Joint dislocation reduction
    • Fracture reduction
    • Wound care, i.e. large laceration repair
  • Analgesia especially for major pain, i.e. multiple ribs fractures, flail chest and femoral fracture.

Knobology

  • A linear array probe is required
  • Adjust frequency to the highest setting (optimal frequency is 12-18 MHz). Adjust according to patient habits, i.e. lower the frequent if the patient is obese.
  • It is easier to identify the nerve in short axis and work in transverse plane.
  • Hold the probe with indicator to your left.

Preparation

  • Forearm nerve block superficial cervical plexus block and supraclavicular brachial plexus block are semi-sterile procedures. Femoral nerve block is a sterile procedure.
  • Essential: sterile probe covers, gloves, gel and antiseptic. Needle gauge and length selection depend on the type of block. A longer, 3.5 inches spinal needle may be an option for femoral blocks. Non-Cutting tip needed, for example Whitacre pencil point may reduce nerve injury.
  • Consider attach a short extension tube to the needle for femoral nerve block if you have assistant or extra hands that can help with aspiration and injection while you are handling the needle.

Identifying the nerves

Technique

Images

Normal

Abnormal

Pearls and Pitfalls

Documentation

Normal Exam

Abnormal Exam

Clips

External Links

See Also

References

  1. ↑ Wilson JE. et al. Oligoanalgesia in the emergency department. Am J Emerg Med. 1989 Nov;7(6):620-3.
  2. ↑ McQuay HJ. et al. Postoperative orthopaedic pain-the effect of opiate premedication and local anaesthetic blocks.Pain. 1988 Jun;33(3):291-5.
  3. ↑ Liebmann O. et al.Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006 Nov;48(5):558-62.
  4. ↑ Stone MB. et al.Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. Am J Emerg Med. 2008 Jul;26(6):706-10.
  5. ↑ Blaivas M et al.Ultrasound-guided interscalene block for shoulder dislocation reduction in the ED.Am J Emerg Med. 2006 May;24(3):293-6.
  6. ↑ Beaudoin FL. et al.Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures.Am J Emerg Med. 2010 Jan;28(1):76-81.
  7. ↑ Lewis SR. et al. Ultrasound guidance for upper and lower limb blocks.Cochrane Database Syst Rev. 2015 Sep 11;(9)
  8. ↑ Walker KJ. et al. Ultrasound guidance for peripheral nerve blockade.Cochrane Database Syst Rev. 2009 Oct 7;(4)
  9. ↑ Neal JM. et al. The ASRA evidence-based medicine assessment of ultrasound-guided regional anesthesia and pain medicine: Executive summary.Reg Anesth Pain Med. 2010 Mar-Apr;35(2 Suppl):S1-9


Obtenido de «https://www.wikem.org/w/index.php?title=Ultrasound:_Nerves&oldid=115353»