Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942007000100012
Brazilian Journal of Anesthesiology
Miscellaneous

Bloqueios nervosos guiados por ultra-som

Ultrasound-guided nerve blocks

Pablo Escovedo Helayel; Diogo Brüggemann da Conceição; Getúlio Rodrigues de Oliveira Filho

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Resumo

JUSTIFICATIVA E OBJETIVOS: As técnicas de bloqueios nervosos guiados por ultra-som são baseadas na visualização direta das estruturas nervosas, da agulha de bloqueio e das estruturas anatômicas adjacentes. Desta maneira, é possível depositar a solução de anestésico local precisamente em torno dos nervos e acompanhar a sua dispersão em tempo real, obtendo-se, assim, um bloqueio mais eficaz, de menor latência, menor dependência de referências anatômicas, menor volume de solução anestésica e maior segurança. CONTEÚDO: O artigo revisa os aspectos relativos aos mecanismos físicos para formação de imagens, a anatomia ultra-sonográfica do neuroeixo e dos plexos braquial e lombossacral, os equipamentos e materiais empregados nos bloqueios, os ajustes do aparelho de ultra-som para melhorar as imagens, os planos de visualização das agulhas de bloqueio e as técnicas e o treinamento em bloqueios guiados por ultra-som. CONCLUSÕES: Os passos para se obter sucesso em anestesia regional incluem a identificação exata da posição dos nervos, a localização precisa da agulha, sem lesões nas estruturas adjacentes e, finalmente, a injeção cuidadosa de anestésico local junto aos nervos. Embora a neuroestimulação forneça grande auxílio na identificação dos nervos, esta não consegue, isoladamente, preencher todas essas exigências. Por isso, acredita-se que os bloqueios guiados por ultra-som serão a técnica de eleição para anestesia regional num futuro não muito distante.

Palavras-chave

ANESTESIA, Regional, EQUIPAMENTOS, Ultra-som, TÉCNICAS ANESTÉSICAS: Regional

Abstract

BACKGROUND AND OBJECTIVES: Ultrasound-guided nerve blocks are based on the direct visualization of nerve structures, needle, and adjacent anatomic structures. Thus, it is possible to place the local anesthetic precisely around the nerves and follow its dispersion in real time, obtaining, therefore, more effective blockades, reduced dependency on anatomic references, decreased anesthetic volume, and increased safety. CONTENTS: The aim of this paper was to review the physical mechanisms of image formation, ultrasound anatomy of the neuro axis and of the brachial and lumbosacral plexuses, equipment and materials used in the blockades, settings of the ultrasound equipment to improve the image, planes of visualization of the needles, the techniques, and training in ultrasound-guided nerve blocks. CONCLUSIONS: The steps for a successful regional block include the identification of the exact position of the nerves, the precise localization of the needle, without causing injuries to adjacent structures, and, finally, the careful administration of the local anesthetic close to the nerves. Although neurostimulation is very useful in identifying nerves, it does not fulfill all those requirements. Therefore, it is believed that ultrasound-guided nerve blocks will be the technique of choice in regional anesthesia in a not too distant future.

Keywords

ANESTHESIA, Regional, EQUIPMENT, Ultrasound, ANESTHETIC TECHNIQUES, Regional block

References

la Grange P, Foster PA, Pretorius LK. Application of the Doppler ultrasound bloodflow detector in supraclavicular brachial plexus block. Br J Anaesth. 1978;50:965-967.

Cork RC, Kryc JJ, Vaughan RW. Ultrasonic localization of the lumbar epidural space. Anesthesiology. 1980;52:513-516.

Currie JM. Measurement of the depth to the extradural space using ultrasound. Br J Anaesth. 1984;56:345-347.

Grau T. The evaluation of ultrasound imaging for neuraxial anesthesia. Can J Anesth. 2003;50:R7.

Marhofer P, Greher M, Kapral S. Ultrasound guidance in regional anaesthesia. Br J Anaesth. 2005;94:7-17.

Adler RS, Sofka CM. Percutaneous ultrasound-guided injections in the musculoskeletal system. Ultrasound Q. 2003;19:3-12.

Beekman R, Visser LH. High-resolution sonography of the peripheral nervous system: a review of the literature. Eur J Neurol. 2004;11:305-314.

Graif M, Seton A, Nerubai J. Sciatic nerve: sonographic evaluation and anatomic-pathologic considerations. Radiology. 1991;181:405-408.

Silvestri E, Martinoli C, Derchi LE. Echotexture of peripheral nerves: correlation between US and histologic findings and criteria to differentiate tendons. Radiology. 1995;197:291-296.

Sheppard DG, Iyer RB, Fenstermacher MJ. Brachial plexus: demonstration at US. Radiology. 1998;208:402-406.

Steiner E, Nasel C. Sonography of peripheral nerves: basic principles. Acta Anaesthesiol Scand. 1998;42(^s112):46-48.

Yang WT, Chui PT, Metreweli C. Anatomy of the normal brachial plexus revealed by sonography and the role of sonographic guidance in anesthesia of the brachial plexus. AJR Am J Roentgenol. 1998;171:1631-1636.

Heinemeyer O, Reimers CD. Ultrasound of radial, ulnar, median, and sciatic nerves in healthy subjects and patients with hereditary motor and sensory neuropathies. Ultrasound Med Biol. 1999;25:481-485.

Martinoli C, Bianchi S, Derchi LE. Ultrasonography of peripheral nerves. Semin Ultrasound CT MR. 2000;21:205-213.

Grau T, Leipold R, Conradi R. Ultraschall und periduralanasthesie: Technische moglichkeiten und grenzen einer diagnostischen untersuchung des periduralraums. Anaesthesist. 2001;50:94-101.

Martinoli C, Bianchi S, Santacroce E. Brachial plexus sonography: a technique for assessing the root level. AJR Am J Roentgenol. 2002;179:699-702.

Kirvela O, Svedstrom E, Lundbom N. Ultrasonic guidance of lumbar sympathetic and celiac plexus block: a new technique. Reg Anesth. 1992;17:43-46.

Eichenberger U, Greher M, Kapral S. Sonographic visualization and ultrasound-guided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain. Anesthesiology. 2006;104:303-308.

Friedl W, Fritz T. Sonographisch assistierte plexus-brachilais-anaesthesie. Chirurg. 1992;63:759-760.

Kapral S, Krafft P, Eibenberger K. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg. 1994;78:507-513.

Kapral S, Krafft P, Gosch M. Ultrasound imaging for stellate ganglion block: direct visualization of puncture site and local anesthetic spread. A pilot study. Reg Anesth. 1995;20:323-328.

Marhofer P, Schrogendorfer K, Koinig H. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg. 1997;85:854-857.

Chan VW. Applying ultrasound imaging to interscalene brachial plexus block. Reg Anesth Pain Med. 2003;28:340-343.

Gray AT, Collins AB, Schafhalter-Zoppoth I. Sciatic nerve block in a child: a sonographic approach. Anesth Analg. 2003;97:1300-1302.

Chan VW, Perlas A, Rawson R. Ultrasound-guided supraclavicular brachial plexus block. Anesth Analg. 2003;97:1514-1517.

Nadig M, Ekatodramis G, Borgeat A. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth. 2003;90:107-108.

McCartney CJ, Brauner I, Chan VW. Ultrasound guidance for a lateral approach to the sciatic nerve in the popliteal fossa. Anaesthesia. 2004;59:1023-1025.

Marhofer P, Sitzwohl C, Greher M. Ultrasound guidance for infraclavicular brachial plexus anaesthesia in children. Anaesthesia. 2004;59:642-646.

Kirchmair L, Enna B, Mitterschiffthaler G. Lumbar plexus in children: A sonographic study and its relevance to pediatric regional anesthesia. Anesthesiology. 2004;101:445-450.

Kovacs P, Gruber H, Piegger J. New, simple, ultrasound-guided infiltration of the pudendal nerve: ultrasonographic technique. Dis Colon Rectum. 2001;44:1381-1385.

Grau T, Leipold RW, Conradi R. Ultrasound imaging facilitates localization of the epidural space during combined spinal and epidural anesthesia. Reg Anesth Pain Med. 2001;26:64-67.

Grau T, Leipold RW, Conradi R. Ultrasound control for presumed difficult epidural puncture. Acta Anaesthesiol Scand. 2001;45:766-771.

Gray AT, Collins AB. Ultrasound-guided saphenous nerve block. Reg Anesth Pain Med. 2003;28:148.

Willschke H, Marhofer P, Bosenberg A. Ultrasonography for ilioinguinal/iliohypogastric nerve blocks in children. Br J Anaesth. 2005;95:226-230.

Awad IT, Chan V. Ultrasound imaging of peripheral nerves: a need for a new trend. Reg Anesth Pain Med. 2005;30:321-323.

Ootaki C, Hayashi H, Amano M. Ultrasound-guided infraclavicular brachial plexus block: an alternative technique to anatomical landmark-guided approaches. Reg Anesth Pain Med. 2000;25:600-604.

Williams SR, Chouinard P, Arcand G. Ultrasound guidance speeds execution and improves the quality of supraclavicular block. Anesth Analg. 2003:97.

Schafhalter-Zoppoth I, Zeitz ID, Gray AT. Inadvertent femoral nerve impalement and intraneural injection visualized by ultrasound. Anesth Analg. 2004;99:627-628.

Chan VW. Ultrasound evidence of intraneural injection. Anesth Analg. 2005;101:610-611.

Rapp HJ, Folger A, Grau T. Ultrasound-guided epidural catheter insertion in children. Anesth Analg. 2005;101:333-339.

Ting PL, Sivagnanaratnam V. Ultrasonographic study of the spread of local anaesthetic during axillary brachial plexus block. Br J Anaesth. 1989;63:326-329.

Greher M, Kapral S. Is regional anesthesia simply an exercise in applied sonoanatomy?: aiming at higher frequencies of ultrasonographic imaging. Anesthesiology. 2003;99:250-251.

Sandhu NS, Bahniwal CS, Capan LM. Feasibility of an infraclavicular block with a reduced volume of lidocaine with sonographic guidance. J Ultrasound Med. 2006;25:51-56.

Marhofer P, Schrogendorfer K, Wallner T. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med. 1998;23:584-588.

Kossoff G. Basic physics and imaging characteristics of ultrasound. World J Surg. 2000;24:134-142.

Perlas A, Chan VW, Simons M. Brachial plexus examination and localization using ultrasound and electrical stimulation: a volunteer study. Anesthesiology. 2003;99:429-435.

Sites BD, 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.

Sinha A, Chan VW. Ultrasound imaging for popliteal sciatic nerve block. . 2004;29:130-134.

Arcand G, Williams SR, Chouinard P. Ultrasound-guided infraclavicular versus supraclavicular block. Anesth Analg. 2005;101:886-890.

De Andres J, Sala-Blanch X. Ultrasound in the practice of brachial plexus anesthesia. Reg Anesth Pain Med. 2002;27:77-89.

Chan VW, Nova H, Abbas S. Ultrasound examination and localization of the sciatic nerve: A volunteer study. Anesthesiology. 2006;104:309-314.

Rose SC, Nelson TR. Ultrasonographic modalities to assess vascular anatomy and disease. J Vasc Interv Radiol. 2004;15:25-38.

Demondion X, Herbinet P, Boutry N. Sonographic mapping of the normal brachial plexus. AJNR Am J Neuroradiol. 2003;24:1303-1309.

Schafhalter-Zoppoth I, Gray AT. The musculocutaneous nerve: ultrasound appearance for peripheral nerve block. Reg Anesth Pain Med. 2005;30:385-390.

Gray AT. Role of ultrasound in startup regional anesthesia practice for outpatients. . 2005;43:69-78.

Dabu A, Chan VW. A Practical Guide to Ultrasound Imaging for Peripheral Nerve Blocks. 2004.

Retzl G, Kapral S, Greher M. Ultrasonographic findings of the axillary part of the brachial plexus. Anesth Analg. 2001;92:1271-1275.

Fornage BD, Rifkin MD. Ultrasound examination of tendons. Radiol Clin North Am. 1988;26:87-107.

Chiou HJ, Chou YH, Chiou SY. Peripheral nerve lesions: role of high-resolution US. Radiographics. 2003;23.

Grechenig W, Clement HG, Peicha G. Die sonoanatomie des nervus ischiadicus am oberschenkel. Biomed Tech. 2000;45:298-303.

Soong J, Schafhalter-Zoppoth I, Gray AT. The importance of transducer angle to ultrasound visibility of the femoral nerve. Reg Anesth Pain Med. 2005;30:505.

Peer S, Kovacs P, Harpf C. High-resolution sonography of lower extremity peripheral nerves: anatomic correlation and spectrum of disease. J Ultrasound Med. 2002;21:315-322.

Sener RN, Alper H, Ozturk L. Retroperitoneal part of the femoral nerve: Normal ultrasound features. Neuroradiology. 1991;33:159-161.

Gruber H, Peer S, Kovacs P. The ultrasonographic appearance of the femoral nerve and cases of iatrogenic impairment. J Ultrasound Med. 2003;22:163-172.

Furness G, Reilly MP, Kuchi S. An evaluation of ultrasound imaging for identification of lumbar intervertebral level. Anaesthesia. 2002;57:277-280.

Grau T. Ultrasonography in the current practice of regional anaesthesia. Best Pract Res Clin Anaesthesiol. 2005;19:175-200.

Grau T, Leipold RW, Horter J. Paramedian access to the epidural space: the optimum window for ultrasound imaging. J Clin Anesth. 2001;13:213-217.

Bonazzi M, Bianchi De Grazia L, Di Gennaro S. Individuazione ecoguidata dello spazio epidurale lombare. Minerva Anestesiol. 1995;61:201-205.

Marhofer P, Bosenberg A, Sitzwohl C. Pilot study of neuraxial imaging by ultrasound in infants and children.. Paediatr Anaesth. 2005;15:671-676.

Rapp HJ, Grau T. Ultrasound imaging in pediatric regional anesthesia. Can J Anaesth. 2004;51:277-278.

Schafhalter-Zoppoth I, McCulloch CE, Gray AT. Ultrasound visibility of needles used for regional nerve block: an in vitro study. Reg Anesth Pain Med. 2004;29:480-488.

Gray AT. Ultrasound-guided regional anesthesia: current state of the art. Anesthesiology. 2006;104:368-373.

Nichols K, Wright LB, Spencer T. Changes in ultrasonographic echogenicity and visibility of needles with changes in angles of insonation. J Vasc Interv Radiol. 2003;14:1553-1557.

Sandhu NS, Capan LM. Ultrasound-guided infraclavicular brachial plexus block. Br J Anaesth. 2002;89:254-259.

Sandhu NS, Maharlouei B, Patel B. Simultaneous bilateral infraclavicular brachial plexus blocks with low-dose lidocaine using ultrasound guidance. Anesthesiology. 2006;104:199-201.

Abramowicz JS. Technical advances in ultrasound equipment. Clin Obstet Gynecol. 2003;46:839-849.

Lin DC, Nazarian LN, O'Kane PL. Advantages of real-time spatial compound sonography of the musculoskeletal system versus conventional sonography. AJR Am J Roentgenol. 2002;179:1629-1631.

Meuwly JY, Thiran JP, Gudinchet F. Application of adaptive image processing technique to real-time spatial compound ultrasound imaging improves image quality. Invest Radiol. 2003;38:257-262.

Sodhi KS, Sidhu R, Gulati M. Role of tissue harmonic imaging in focal hepatic lesions: comparison with conventional sonography. J Gastroenterol Hepatol. 2005;20:1488-1493.

Grau T, Bartusseck E, Conradi R. Ultrasound imaging improves learning curves in obstetric epidural anesthesia: a preliminary study. Can J Anaesth. 2003;50:1047-1050.

Sites BD, Gallagher JD, Cravero J. The learning curve associated with a simulated ultrasound-guided interventional task by inexperienced anesthesia residents. Reg Anesth Pain Med. 2004;29:544-548.

Porter JM, McCartney CJ, Chan VW. Needle placement and injection posterior to the axillary artery may predict successful infraclavicular brachial plexus block: a report of three cases. Can J Anaesth. 2005;52:69-73.

Tsui BC, Finucane B. Practical recommendations for improving needle-tip visibility under ultrasound guidance?. Reg Anesth Pain Med. 2005;30:596-597.

Minville V, Zetlaoui PJ, Fessenmeyer C. Ultrasound guidance for difficult lateral popliteal catheter insertion in a patient with peripheral vascular disease. Reg Anesth Pain Med. 2004;29:368-370.

Greher M, Retzl G, Niel P. Ultrasonographic assessment of topographic anatomy in volunteers suggests a modification of the infraclavicular vertical brachial plexus block. Br J Anaesth. 2002;88:632-636.

Li C MCC, Perlas A, Chan V. Successful use of ultrasound guided axillary block in three morbidly obese patients. Reg Anesth Pain Med. 2004;29:A52.

Wallace DH, Currie JM, Gilstrap LC. Indirect sonographic guidance for epidural anesthesia in obese pregnant patients. Reg Anesth. 1992;17:233-236.

Nielsen KC, Guller U, Steele SM. Influence of obesity on surgical regional anesthesia in the ambulatory setting: an analysis of 9,038 blocks. Anesthesiology. 2005;102:181-187.

Grau T, Leipold RW, Conradi R. Efficacy of ultrasound imaging in obstetric epidural anesthesia. J Clin Anesth. 2002;14:169-175.

Grau T, Leipold RW, Conradi R. Die darstellung von duraperforationen und bloodpatches mit ultraschall. Anasthesiol Intensivmed Notfallmed Schmerzther. 2002;37:149-153.

Chawathe MS, Jones RM, Gildersleve CD. Detection of epidural catheters with ultrasound in children. Paediatr Anaesth. 2003;13:681-684.

Roberts SA, Galvez I. Ultrasound assessment of caudal catheter position in infants. Paediatr Anaesth. 2005;15:429-432.

Denny NM, Harrop-Griffiths W. Location, location, location! Ultrasound imaging in regional anaesthesia. Br J Anaesth. 2005;94:1-3.

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