Abstract
In recent years, there has been increasing interest and enthusiasm for using ultrasound guidance in performing peripheral nerve blocks. The use of ultrasound guidance in regional anesthesia has led to increased use of peripheral nerve blocks and greater acceptance by healthcare providers across different specialties. Ultrasound-guided nerve blocks offer effective and safe alternatives to achieve pain control and perform a variety of medical procedures in the acute care settings. They are associated with numerous benefits including improved analgesia, decreased intravenous narcotic use, decreased complications, and reduced length of stay. Ultrasound allows real-time visualization of the anatomy of the region of interest and path of the needle resulting in accurate deposition and spread of local anesthetic around the target nerve. Ultrasound guidance has been shown to improve operator confidence and overall success rates of peripheral nerve blocks. In this chapter, we will review the basic principles of ultrasound-guided nerve blocks and a variety of upper and lower extremity ultrasound-guided nerve block techniques including the brachial plexus, forearm (median, radial, and ulnar nerves), femoral, and posterior tibial nerve blocks. These nerve blocks are described in a way that they can be incorporated into your clinical setting with already available equipment and supplies.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Tirado A, Nagdev A, Henningsen C, Breckon P, Chiles K. Ultrasound-guided procedures in the emergency department-needle guidance and localization. Emerg Med Clin North Am. 2013;31(1):87–115.
Walker KJ, McGrattan K, Aas-Eng K, Smith AF. Ultrasound guidance for peripheral nerve blockade. Cochrane Database Syst Rev. 2009;(4):CD006459.
Chin KJ, Wong NWY, Macfarlane AJR, Chan VWS. Ultrasound-guided versus anatomic landmark-guided ankle blocks: a 6-year retrospective review. Reg Anesth Pain Med. 2011;36(6):611–8.
Neal JM, Bernards CM, Hadzic A, et al. ASRA practice advisory on neurologic complications in regional anesthesia and pain medicine. Reg Anesth Pain Med. 2008;33(5):404–15.
Prakash S, Kumar A. Needle tip and peripheral nerve blocks. J Anaesthesiol Clin Pharmacol. 2018;34(1):129–30.
Becker DE, Reed KL. Local anesthetics: review of pharmacological considerations. Anesth Prog. 2012;59(2):90–101, quiz 102–3.
Johnson B, Herring A, Stone M, Nagdev A. Performance accuracy of hand-on-needle versus hand-on-syringe technique for ultrasound-guided regional anesthesia simulation for emergency medicine residents. West J Emerg Med. 2014;15(6):641–6.
Urmey WF, Talts KH, Sharrock NE. One hundred percent incidence of hemidiaphragmatic paresis associated with interscalene brachial plexus anesthesia as diagnosed by ultrasonography. Anesth Analg. 1991;72(4):498–503.
Riazi S, Carmichael N, Awad I, Holtby RM, McCartney CJL. Effect of local anaesthetic volume (20 vs 5 ml) on the efficacy and respiratory consequences of ultrasound-guided interscalene brachial plexus block. Br J Anaesth. 2008;101(4):549–56.
Spence BC, Beach ML, Gallagher JD, Sites BD. Ultrasound-guided interscalene blocks: understanding where to inject the local anaesthetic. Anaesthesia. 2011;66(6):509–14.
Stone MB, Wang R, Price DD. Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. Am J Emerg Med. 2008;26(6):706–10.
Blaivas M, Adhikari S, Lander L. A prospective comparison of procedural sedation and ultrasound-guided interscalene nerve block for shoulder reduction in the emergency department. Acad Emerg Med. 2011;18(9):922–7.
Mak PH, Irwin MG, Ooi CG, Chow BF. Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function. Anaesthesia. 2001;56(4):352–6.
Perlas A, Lobo G, Lo N, Brull R, Chan VW, Karkhanis R. Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases. Reg Anesth Pain Med. 2009;34:171–6.
De José María B, Banús E, Navarro Egea M, Serrano S, Perelló M, Mabrok M. Ultrasound-guided supraclavicular vs infraclavicular brachial plexus blocks in children. Paediatr Anaesth. 2008;18(9):838–44.
Herring AA, Stone MB, Frenkel O, Chipman A, Nagdev AD. The ultrasound-guided superficial cervical plexus block for anesthesia and analgesia in emergency care settings. Am J Emerg Med. 2012;30(7):1263–7.
Choi DS, Atchabahian A, Brown AR. Cervical plexus block provides postoperative analgesia after clavicle surgery. Anesth Analg. 2005;100(5):1542–3.
Sepulveda TGA, Soto NRA, Cortes AJE, Suazo GIC. Efficacy of anesthetic blockage of superficial branches of the cervical plexus. Int J Odontostomatol. 2008;2(1):77–81.
Shanthanna H. Ultrasound guided selective cervical nerve root block and superficial cervical plexus block for surgeries on the clavicle. Indian J Anaesth. 2014;58(3):327–9.
Shteif M, Lesmes D, Hartman G, Ruffino S, Laster Z. The use of the superficial cervical plexus block in the drainage of submandibular and submental abscesses—an alternative for general anesthesia. J Oral Maxillofac Surg. 2008;66(12):2642–5.
Pandit JJ, Dutta D, Morris JF. Spread of injectate with superficial cervical plexus block in humans: an anatomical study. Br J Anaesth. 2003;91(5):733.
Castresana MR, et al. Incidence and clinical significance of hemidiaphragmatic paresis in patients undergoing carotid endarterectomy during cervical plexus block anesthesia. J Neurosurg Anesthesiol. 1994;6(1):21–3.
Flores S, Riguzzi C, Herring A, Nagdev A. Horner’s syndrome after superficial cervical plexus block. West J Emerg Med. 2015;16(3):428–31.
Çiftci T, Daskaya H, Yıldırım MB, Söylemez H. A minimally painful, comfortable, and safe technique for hemodialysis catheter placement in children: superficial cervical plexus block. Hemodial Int. 2014;18:700–4.
Boles C, Kannam S, Cardwell A. The forearm anatomy of muscle compartments and nerves. Am J Roentgenol. 2000;174:151–9.
Mazurek MT, Shin AY. Upper extremity peripheral nerve anatomy: current concepts and applications. Clin Orthop Relat Res. 2001;383:7–20.
Brown JM, Yablon CM, Morag Y, Brandon CJ, Jacobson JA. US of the peripheral nerves of the upper extremity: a landmark approach. Radiographics. 2016;36(2):452–63.
Ferrera PC, Chandler R. Anesthesia in the emergency setting: Part I. Hand and foot injuries. Am Fam Physician. 1994;50:569–73.
Salam GA. Regional anesthesia for office procedures: Part II. Extremity and inguinal area surgeries. Am Fam Physician. 2004;69:896–9.
McCartney CJ, Xu D, Constantinescu C, Abbas S, Chan VW. Ultrasound examination of peripheral nerves in the forearm. Reg Anesth Pain Med. 2007;32(5):434–9.
Liebmann O, Price D, Mills C, et al. Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006;48:558–62.
Frenkel O, Liebmann O, Fischer JW. Ultrasound-guided forearm nerve blocks in kids: a novel method for pain control in the treatment of hand-injured pediatric patients in the emergency department. Pediatr Emerg Care. 2015;31(4):255–9.
Sohoni A, Nagdev A, Takhar S, et al. Forearm ultrasound-guided nerve blocks vs landmark-based wrist blocks for hand anesthesia in healthy volunteers. Am J Emerg Med. 2016;34(4):730–4.
Beaudoin FL, Haran JP, Liebmann O. A comparison of ultrasound-guided three-in-one femoral nerve block versus parenteral opioids alone for analgesia in emergency department patients with hip fractures: a randomized controlled trial. Acad Emerg Med. 2013;20(6):584–91.
Karagiannis G, Hardern R. Best evidence topic report. No evidence found that a femoral nerve block in cases of femoral shaft fractures can delay the diagnosis of compartment syndrome of the thigh. Emerg Med J. 2005;22(11):814.
Johnson B, Herring A, Shah S, Krosin M, Mantuani D, Nagdev A. Door-to-block time: prioritizing acute pain management for femoral fractures in the ED. Am J Emerg Med. 2014;32(7):801–3.
Beaudoin FL, Nagdev A, Merchant RC, Becker BM. Ultrasound-guided femoral nerve blocks in elderly patients with hip fractures. Am J Emerg Med. 2010;28(1):76–81.
Fletcher AK, Rigby AS, Heyes FL. Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial. Ann Emerg Med. 2003;41(2):227–33.
Mutty CE, Jensen EJ, Manka MA Jr, Anders MJ, Bone LB. Femoral nerve block for diaphyseal and distal femoral fractures in the emergency department. J Bone Joint Surg Am. 2007;89(12):2599.
Marhofer P, Harrop-Griffiths W, Willschke H, et al. Fifteen years of ultrasound guidance in regional anaesthesia: part 2—recent developments in block techniques. Br J Anaesth. 2010;104:673–83.
Murray JM, Derbyshire S, Shields MO. Lower limb blocks. Anaesthesia. 2010;65:57–66.
Herring AA, Stone MB, Fischer J, et al. Ultrasound-guided distal popliteal sciatic nerve block for ED anesthesia. Am J Emerg Med. 2011;29:e3–5.
Moore C. Ultrasound-guided procedures in emergency medicine. Ultrasound Clin. 2011;6:277–89.
Mori T, Hagiwara Y. Ultrasound-guided popliteal sciatic nerve block for an ankle laceration in a pediatric emergency department. Pediatr Emerg Care. 2017;33(12):803–5.
Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth. 2009;102(1):3–11.
Redborg KE, Antonakakis JG, Beach ML, Chinn CD, Sites BD. Ultrasound improves the success rate of a tibial nerve block at the ankle. Reg Anesth Pain Med. 2009;34(3):256–60.
Clattenburg E, Herring A, Hahn C, Johnson B, Nagdev A. ED ultrasound-guided posterior tibial nerve blocks for calcaneal fracture analagesia. Am J Emerg Med. 2016;34(6):1183.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Nagdev, A., Lovallo, E., Johnson, B. (2020). Ultrasound-Guided Nerve Blocks. In: Adhikari, S., Blaivas, M. (eds) The Ultimate Guide to Point-of-Care Ultrasound-Guided Procedures . Springer, Cham. https://doi.org/10.1007/978-3-030-28267-7_9
Download citation
DOI: https://doi.org/10.1007/978-3-030-28267-7_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-28265-3
Online ISBN: 978-3-030-28267-7
eBook Packages: MedicineMedicine (R0)