Koizuka Shiro, Nakajima Kunie, Mieda Rie
Department of Anesthesiology, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, 371-8511, Japan,
J Anesth. 2014 Feb;28(1):94-101. doi: 10.1007/s00540-013-1675-8. Epub 2013 Jul 20.
Nerve blocks are an attractive interventional therapy in pain medicine. Several image guidance methods are available to secure the safety, accuracy, and selectivity of the nerve block. Computed tomography (CT) guidance provides a clear view of the vital viscera and vessels that should be avoided by the needle, and accurate placement of the needle tip before neuro-destructive procedures. A recent advance in CT technology is multi-slice CT fluoroscopy, which allows for rapid and easy correction of needle tip placement during insertion. To reduce the radiation dose for both patients and staff, the lowest radiation setting, intermittent quick-check fluoroscopy, and shortening of the planning scan should be used. Preliminary CT scanning with excellent spatial resolution may facilitate the application of CT fluoroscopic guidance to various types of nerve blocks. Here we review celiac plexus and splanchnic nerve blocks, trigeminal nerve block, neurolytic sympathectomy, and spinal intervention performed under CT guidance. Additional large-scale studies are needed to optimize the use of image guidance, especially CT fluoroscopy guidance, for nerve blocks.
神经阻滞是疼痛医学中一种有吸引力的介入治疗方法。有几种图像引导方法可用于确保神经阻滞的安全性、准确性和选择性。计算机断层扫描（CT）引导能清晰显示穿刺针应避开的重要内脏和血管，并在进行神经毁损手术前准确放置针尖。CT技术的一项最新进展是多层CT透视，它能在穿刺过程中快速且轻松地校正针尖位置。为减少患者和工作人员的辐射剂量，应使用最低辐射设置、间歇性快速检查透视以及缩短计划扫描时间。具有出色空间分辨率的初步CT扫描可能有助于将CT透视引导应用于各种类型的神经阻滞。在此，我们回顾在CT引导下进行的腹腔神经丛和内脏神经阻滞、三叉神经阻滞、神经溶解交感神经切除术以及脊柱介入。需要更多大规模研究来优化图像引导（尤其是CT透视引导）在神经阻滞中的应用。
