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Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

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Nội dung chi tiết: Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2IntroductionPeripheral nerve block techniques have traditionally been performed based (Hl nerve identification from surface anatomical landmarks and n

eurostimulation. Anatomical variation among individuals often makes these techniques difficult and may result in variable success and serious complica Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

tions such as bleeding, nerve injury, local anesthetic systemic toxicity (LAST), and pneumothorax.Ultrasound is the first imaging modality to be broad

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

ly used in regional anesthesia practice. Ultrasound-guided regional anesthesia (UGRA) uses real-time imaging to appreciate individual anatomic variati

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2antages over traditional methods have resulted in improved nerve block safety, efficacy, and efficiency 11. 2|.The brachial plexus and its branches ar

e particularly amenable to sonographic examination, given their superficial location, with high-frequency (> 10 MHz) linear array probes providing hig Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

h-resolution images.Brachial Plexus AnatomyThorough knowledge of brachial plexus anatomy is required to facilitate block placement and to optimize pat

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

ient specific block selection. The four traditional “windows” for brachial plexus block are the inlerscalene level (roots), supraclavicular level (tru

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2tinuum that may be imaged and anesthetized almost anywhere along its course.J. Me Vicar • s. Riazi - A. Portas (IS)Department of Anesthesia, Universit

y <>r Toronto, Toronto WesternI losptlal. Toronto, ON, Canadae-mail: anahi.pertas@uhn.on.caThe hrachial plexus provides sensory and motor innervation Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

to the upper limb. It originates from the ventral primary rami of the fifth cervical (C5) to the first thoracic (Tl) spinal nerve roots and extends fr

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

om the neck to the apex of the axilla (Fig. 19.3). Variable contributions may also come from C4 lo T2 nerves. The C5 and C6 rami typically unite near

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2 unite to form the inferior trunk. The C7 transverse process lacks an anterior tubercle, which facilitates the ultrasonographic identification of the

C7 nerve root [3,4|. The roots and trunks pass through (he interscalene groove, a palpable surface anatomic landmark between the anterior and middle s Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

calene muscles. The three trunks undergo primary anatomic separation into anterior (flexor) and posterior (extensor) divisions at the lateral border o

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

f the first rib [5|. The anterior divisions of the superior and middle trunks form the lateral cord of the plexus, the posterior divisions of all thre

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2erminal branches of the plexus, with each cord possessing two major terminal branches and a variable number of minor intermediary branches. The latera

l cord contributes the musculocutaneous nerve and the lateral component of the median nerve. The posterior cord supplies the dorsal aspect of the uppe Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

r extremity via the radial and axillary nerves. The medial cord contributes the ulnar nerve and the medial component of the median nerve. Important in

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

termediary branches of the medial cord include the medial cutaneous nerves of the arm and forearm and the intercostobrachial nerve (T2) to innervate t

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2s; the long thoracic nerve (C5-7) supplies the serratus anterior muscle; (he thoracodorsal nerve (C6-8) supplies the latissimus dorsi muscle: and the

suprascapular nerve supplies the supraspi-nalus and infraspinatus muscles.o Springer Science+Business Media. LLC. part of springer Nature 2018185s. N. Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

Narouze (cd.). Alius of Ultrasound-Guided Procedures in Interventional Pain Management.https://doi.org/IO. 1007/978-1 -4939-7754-3.19186J. McVicar et

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

al.Fig. 19.1 The core components of safe ultrasound-guided regional anesthesia The image i-s acquired in the desired anatomical region and is optimiz

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2e to be avoided, such as vessels and lung, to plan a safe needle path. The needle is guided to live target in real time while maintaining a view of th

e needle tip. The deposition of local anesthetic is visualized in real lime. (Reproduced with permission from WWW. usra.ca)The superficial cervical pl Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

exus (Cl-4) lies in close proximity to the brachial plexus and gives rise to the phrenic nerve (0-5). which supplies motor innervation to the diaphrag

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

m and lies ventral to the anterior scalene muscle; the supraclavicular nerve (C3-4) provides sensation from the "cape" of the shoulder to the lateral

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2e scalene muscles. In slim patients, this groove can often be palpated along the lateral border of the sternocleidomastoid muscle at the level of the

thyroid cartilage (C6).IndicationThe interscalene block remains the approach of choice to provide anesthesia and analgesia for shoulder surgery. as it Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

targets the proximal roots of the plexus (C4-C7). The inter-scalene space is not a contained fascial plane, as local anesthetic spread extends proxim

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

ally to include the nonbrachial plexus supraclavicular nerve (C3-C4). which supplies sensory innervation to the "cape" of the shoulder and the phrenic

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2eliable analgcsia/ancsthesia of the shoulder. Deltoid and bicep weakness arc a typical finding. The more caudal roots of the plexus (C8-TI) are usuall

y spared by this approach (7).ProcedureThe patient is positioned supine with the head turned 45° to the contralateral side and the arm adducted at the Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

side. A high-frequency linear probe (>10 MHz) is recommended. As the plexus is usually very superficial (<3 cm) a 22-gauge. 50-mm block needle is suf

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

ficient. A transverse image of the plexus roots in the interscalcne area is obtained on the lateral aspect of the neck in an axial oblique plane at th

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2leidomastoid muscle lateral to the carotid artery and internal jugular vein [8].The interscalene nerve roots are best imaged at the C5-7 level, where

they have a round or oval appearance in cross-section. The compact anatomy of the neck region and the hypoechoic nature of both the nerves and vessels Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

make it prudent to first locate the plexus trunks at the supraclavicular level, where the anatomic relationship to the subclavian artery is highly re

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

liable. The interscalene roots may then lx? located by using a "traceback" method in a cephalad direction. The individual root levels are identified b

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2.5). so the transverse processes of the C6 and C7 cervical vertebrae can be readily differentiated by the presence (in C6) or absence (in C7) of an an

terior tubercle. Color Doppler may be used to identify the vertebral artery and vein located adjacent to the transverse process, which lies deep to th Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

e interscalene space. The transverse process of the C6 vertebra has both anterior and posterior tubercles (Fig. 19.6). The anterior tubercle of C6 (Ch

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

assaignac's tubercle) is the most prominent of all the cervical vertebrae; it is bounded by the carotid artery anteriorly and the vertebral artery pos

Part IVUltrasound-Guided Peripheral Nerve Blocks and CathetersUltrasound-Guided Upper Extremity Blocks19Jason McVicar, sheila Riazi, and Anahi PerlasI

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2 consistentanesthesia of the lower trunk |9.IO|.One of the most common side effects of interscalene block is phrenic nerve palsy resulting in transien

t hemidia-phragmatic paresis [11]. Although it is usually asy mptomatic in healthy patients, it may be poorly tolerated in patients with limited respi Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

ratory reserve. As a result, the interscalene block is relatively contraindicated in patients with significant respiratory disease. An ultrasound-guid

Ebook Atlas of ultrasound-guided procedures in interventional pain management (2E): Part 2

ed intcrscalenc block may provide adequate postoperative analgesia with only 5 mL ofhttps://khothuvien.cori!

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