Masui. The Japanese journal of anesthesiology
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Theoretically, sciatic nerve block can be used alone or in combination with lumbar plexus block or femoral nerve block for anesthesia and/or analgesia of lower limb surgery. However, clinical use of sciatic nerve block was limited by technical difficulties in performing the block since techniques used relies only on surface anatomical landmarks. ⋯ In this article we describe the anatomy of the sciatic nerve, sonographic features, and technique of three major approaches including subgluteal, anterior, and popliteal approaches. The use of this technique for postoperative analgesia is also discussed.
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Epidural block is performed with surface landmark guidance and loss of resistance technique. Ultrasound visualization of the spinal column and surrounding structures gives additional anatomical information, which could make the block easier and safer. ⋯ The dura mater is identified as an echogenic structure inside the spinal canal. Prepuncture ultrasound examination offers useful information for epidural block such as puncture point and depth as well as angle to the epidural space.
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Femoral nerve block is well suited for surgery on the anterior aspect of the thigh and knee. The primary indication of continuous femoral nerve block is pain management after major femoral or knee surgery. Ultrasound image guidance for femoral nerve block can improve block success rate and decrease complications. We describe the ultrasound scanning, needling technique, and catheter insertion technique for single-dose technique and continuous infusion technique.
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We reviewed the technique and anatomy for the ultrasound-guided obturator nerve block, especially interadductor approach. Although it is sometimes difficult to observe obturator nerve in the ultrasound image, obturator nerve block is completed observing three muscle layers, adductor longus muscle, adductor blevis muscle and adductor magnus muscle, in the ultrasound image. Local anesthetics are injected between the muscle layers confirming the needle tip and spread of the solution. This technique will reduce incomplete effect or side effects of the obturator nerve block.
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Ultrasound-guided peripheral nerve block has been gaining popularity in the community of anesthesiologists. Despite its well-known clinical benefits, inconsistent success in block has been one of the major limita- tions of conventional peripheral nerve block. Recent development in ultrasound technology enables us to see nerves, needles and surrounding structures in real-time. ⋯ In this article, we introduce some evidences that support the clinical benefits of ultrasound-guided peripheral nerve block, including performance time, quality, onset and duration of sensory blockade, cost analysis and patient satisfaction. However, ultrasound-guidance may be even more dangerous without appropriate imaging of target nerve and surrounding structures, accurate localization of needle tip and assessment of local anesthetic spread around the target nerve. These problems will be solved by future guidelines, teaching program and further advancement in ultrasound technology.