Anaesthesia
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Regional anaesthesia is undergoing a renaissance, perhaps assisted by the introduction of (and enthusiasm for) ultrasound-guided regional anaesthesia into clinical practice. This article summarises the technology and principles of ultrasound imaging in anaesthesia and describes the development of three-dimensional ultrasound imaging, considering whether this new technology has an application in regional anaesthesia.
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In this review, we discuss the central non-neuraxial regional anaesthesia blocks of the abdomen, including intercostal and intrapleural blocks, rectus sheath and ilioinguinal-iliohypogastric blocks, transversus abdominis plane blocks and paravertebral blocks.
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Ultrasound guidance is rapidly becoming the gold standard for regional anaesthesia. There is an ever growing weight of evidence, matched with improving technology, to show that the use of ultrasound has significant benefits over conventional techniques, such as nerve stimulation and loss of resistance. ⋯ The Achilles' heel of ultrasound-guided regional anaesthesia is that anaesthetists are far more familiar with providing general anaesthesia, which in most cases requires skills that are achieved faster and more reliably. To this ends we go on to provide practical advice on ultrasound-guided techniques and the introduction of ultrasound into a department.