Wadhwa Anupama, Kandadai Sunitha Kanchi, Tongpresert Sujittra, Obal Detlef, Gebhard Ralf Erich
Department of Anesthesiology and Perioperative Medicine, University of Louisville Hospital, University of Louisville, 530 S. Jackson Street, Louisville, KY 40202, USA.
Anesthesiol Res Pract. 2011;2011:262070. doi: 10.1155/2011/262070. Epub 2011 Jul 27.
Nerve stimulation and ultrasound have been introduced to the practice of regional anesthesia mostly in the last two decades. Ultrasound did not gain as much popularity as the nerve stimulation until a decade ago because of the simplicity, accuracy and portability of the nerve stimulator. Ultrasound is now available in most academic centers practicing regional anesthesia and is a popular tool amongst trainees for performance of nerve blocks. This review article specifically discusses the role of ultrasonography for deeply situated nerves or plexuses such as the infraclavicular block for the upper extremity and lumbar plexus and sciatic nerve blocks for the lower extremity. Transitioning from nerve stimulation to ultrasound-guided blocks alone or in combination is beneficial in certain scenarios. However, not every patient undergoing regional anesthesia technique benefits from the use of ultrasound, especially when circumstances resulting in difficult visualization such as deep nerve blocks and/or block performed by inexperienced ultrasonographers. The use of ultrasound does not replace experience and knowledge of relevant anatomy, especially for visualization of deep structures. In certain scenarios, ultrasound may not offer additional value and substantial amount of time may be spent trying to find relevant structures or even provide a false sense of security, especially to an inexperienced operator. We look at available literature on the role of ultrasound for the performance of deep peripheral nerve blocks and its benefits.
在过去二十年中，神经刺激和超声技术大多才被引入区域麻醉实践。由于神经刺激器操作简便、准确性高且便于携带，直到十年前，超声的普及程度都不如神经刺激。现在，大多数开展区域麻醉的学术中心都配备了超声设备，并且超声是实习医生进行神经阻滞操作时常用的工具。这篇综述文章专门探讨了超声检查在定位较深的神经或神经丛中的作用，例如上肢的锁骨下阻滞以及下肢的腰丛和坐骨神经阻滞。在某些情况下，单纯或联合使用从神经刺激转为超声引导阻滞是有益的。然而，并非每位接受区域麻醉技术的患者都能从超声的使用中获益，特别是在诸如深部神经阻滞和/或由经验不足的超声检查者进行阻滞等导致可视化困难的情况下。超声的使用并不能取代对相关解剖结构的经验和知识，尤其是对于深部结构的可视化。在某些情况下，超声可能无法提供额外价值，而且可能会花费大量时间试图找到相关结构，甚至给操作者（尤其是经验不足的操作者）带来一种虚假的安全感。我们查阅了关于超声在深部周围神经阻滞操作中的作用及其益处的现有文献。
