Ultrasound Guided
Regional Nerve Blocks
Benefits
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Optimize nerve localization
Visualize surrounding structures
Assess proper needle placement
Identify anomalous anatomy and pathology
Visualize local anesthetic spread
1.
Benefits
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Safer compared to blind injections
Faster performance time
Fewer complications
Less patient discomfort
Enhancement of the quality of nerve blocks and
longer duration
1.
History

Inca Shamans performing trephination chewed
coca leaves and spat into the wound, effecting
local anesthesia.
3.
History
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1884 Austrian ophthalmologist Karl Koller used
liquid cocaine to temporarily numb the eye.
Subsequently, dozens of anesthetic compounds
were developed.
3.
History

1920 Charles Mayo M.D. visited a colleague in
France to learn surgical techniques. He was
exposed to regional nerve blocks and recruited
Gaston Labat M.D. from France to the Mayo
Clinic. He wrote the book “Regional Anesthesia:
Its technique and clinical applications”.
2.
Regional Anesthesia
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Central (Neuraxial) – spinal, epidural, and
caudal.
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Peripheral – includes all other regions.
Definitions
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Echogenicity – refers to tissue texture, grayscale.
Homogenous – little if any variation in echogenicity.
Heterogeneous – variations in echogenicity.
Hypoechoic – low level grayscale pattern.
Hyperechoic – brighter, whiter grayscale pattern.
Isoechoic – same or similar echogenicity to surrounding
tissue.
Anechoic – black, echo free.
5.
Upper Extremity
Interscalene Nerve Block
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Provides complete anesthesia from C5-C7 and
the superficial cervical plexus (SCP).
Commonly used for rotater cuff repairs and total
shoulder arthroplasty.
1.
Interscalene Nerve Block
Supraclavicular Nerve Block
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Provides complete anesthesia from C5-T1.
Any surgical procedure from the shoulder to the
finger tips.
1.
Supraclavicular Nerve Block
Infraclavicular Nerve Block
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Blocks at the cord level of the brachial plexus
Any surgical procedure of the upper extremity
distal to the shoulder joint.
1.
Infraclavicular Nerve Block
Axillary Nerve Block
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Alternative to supraclavicular and infraclavicular nerve blocks.
Need at least 2 needle puncture sites.
Need to anesthetize all branches of the brachial plexus.
Used for elbow, forearm, wrist, and hand surgery. 1.
Axillary Nerve Block
Median and Ulnar Nerve Block
Radial Nerve Block
Lower Extremity Ultrasound Guided
Regional Nerve Blocks
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Femoral
Sciatic
Ankle
Saphenous
Femoral Nerve Block
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Originates from the ventral roots of L2-L4.
Commonly used for total knee arthroplasty,
ACL repairs, hip surgery, and foot and ankle
surgery.
1.
Femoral Nerve Block
Sciatic Nerve Block
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Originates from L4-S3.
Commonly used for lower leg, ankle, and foot
surgery.
Commonly used with a femoral nerve block for
knee surgery.
1.
Sciatic Nerve Block
Ankle Blocks
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Five Nerves
3 superficial – sural, superficial peroneal,
saphenous.
2 deep – tibial and deep peroneal.
Ankle Block
Ankle Block
Ankle Block
References
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6.
Antonakakis, JG., Green, L. Ultrasound Guided Regional Anesthesia. Gulf
Coast Institute September 2012.
Niesen, AD., Hebl, JR. Multimodal Clinical Pathways, Perineural Catheters,
and Ultrasound Guided Regional Anesthesia. The Anesthesiologist’s
Repertoire for the 21st Century. March 2011.
Hameroff, S. What is the Most Important Invention in the Past 2
Thousand Years. Copyright 2012.
Achar, S., Kundu, S. Principles of Office Anesthesia. American Family
Physician. 2002. July 1:66(1) 91-95.
Nelson, B. Green, L. Ultrasound Guided Vascular Access. Gulf Coast
Institute. September 2012.
Bodle, EE., Raghavendra, M. Median Nerve Block. Medscape Reference.
March 2013.