Sasaki Hideaki, Yamauchi Masanori, Ninomiya Takafumi, Tatsumi Haruyuki, Yamakage Michiaki
Department of Anesthesiology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Department of Anesthesiology and Perioperative Medicine, Tohoku University School of Medicine, Seiryo-cho 1-1, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
J Anesth. 2017 Jun;31(3):365-373. doi: 10.1007/s00540-017-2347-x. Epub 2017 Apr 3.
This study demonstrated the effects of perfluorobutane (Sonazoid) with contrast-enhanced ultrasonography (CEUS) to identify the spread of local anesthetics in ultrasound-guided nerve block.
This study consists of simulation, cadaveric, and animal studies. In a simulation study, 1% lidocaine with 10- to 1000-fold diluted Sonazoid, a US-specific contrast agent to diagnose hepatic and breast cancers (0.5 mL), was injected into a resin-based phantom to determine the optimal concentration for ultrasound-guided peripheral nerve block. The enhanced area was measured by direct observation and ultrasonography (US). In the cadaver study, ultrasound-guided sciatic nerve block was performed at the popliteal fossa in the 9 extremities, and 5 mL of the optimally diluted Sonazoid defined in the simulation study with X-ray contrast medium and blue dye was injected. Longitudinal spread of the solution was measured by CEUS, X-ray imaging and anatomical dissection. In the animal study, the optimally diluted Sonazoid was injected around the sciatic nerve of rats (n = 6), and neuronal function and toxicity were evaluated by behavioral and histological estimation.
The simulation study proved that 100-fold diluted Sonazoid was the optimal concentration. In the cadaver study, CEUS and anatomical dissection (r = 0.90, P = 0.0020) or radiography (r = 0.84, P = 0.0072) showed high agreement and correlation with the longitudinal spread. CEUS clearly showed a fine intraneuronal injection image compared to the usual B-mode imaging. The animal study suggested no adverse effects by co-administration of lidocaine and Sonazoid.
CEUS with 100-fold diluted Sonazoid could identify the spread of local anesthetic as well as radiography and anatomical dissection, and distinguish between intra- and extraneuronal injections without neurodegeneration.
本研究旨在证明全氟丁烷（声诺维）联合超声造影（CEUS）在超声引导下神经阻滞中识别局部麻醉药扩散情况的效果。
本研究包括模拟研究、尸体研究和动物研究。在模拟研究中，将1%利多卡因与稀释10至1000倍的声诺维（一种用于诊断肝癌和乳腺癌的超声专用造影剂，0.5毫升）注入树脂模型中，以确定超声引导下外周神经阻滞的最佳浓度。通过直接观察和超声检查（US）测量增强区域。在尸体研究中，在9个肢体的腘窝处进行超声引导下坐骨神经阻滞，并注入5毫升模拟研究中确定的最佳稀释度的声诺维，同时注入X射线造影剂和蓝色染料。通过CEUS、X射线成像和解剖 dissection测量溶液的纵向扩散。在动物研究中，将最佳稀释度的声诺维注入大鼠（n = 6）坐骨神经周围，通过行为和组织学评估来评价神经功能和毒性。
模拟研究证明100倍稀释的声诺维是最佳浓度。在尸体研究中，CEUS与解剖 dissection（r = 0.90，P = 0.0020）或放射摄影（r = 0.84，P = 0.0072）显示出高度一致性和相关性，与纵向扩散情况相符。与常规B模式成像相比，CEUS能清晰显示神经内精细的注射图像。动物研究表明利多卡因和声诺维联合使用无不良影响。
100倍稀释的声诺维联合CEUS能够像放射摄影和解剖 dissection一样识别局部麻醉药的扩散情况，并区分神经内和神经外注射，且不会导致神经变性。
