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      Three-Dimensional Imaging of Commonly Performed Peripheral Blocks: Using a Handheld Point-of-Care Ultrasound System

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          Abstract

          Background

          Handheld ultrasound devices have become popular among clinicians due to their affordability and compatibility with tablets and smartphones. Several handheld ultrasound devices have the capability to construct three-dimensional (3D) images using a traditional two-dimensional (2D) ultrasound transducer.

          Objectives

          The current study aimed to construct 3D images of common peripheral nerve and fascial plane blocks using a handheld ultrasound device with a 2D ultrasound probe.

          Methods

          A total of 10 patients who were scheduled to receive ultrasound-guided peripheral nerve blocks for outpatient surgery and classified as the American Society of Anesthesiologists physical status I or II with a body mass index of ≤ 30 kg/m 2 were included in the study. Patients who presented with anatomical variations during the initial ultrasound scanning were excluded.

          Results

          This study successfully constructed 3D images of 10 peripheral nerve blocks. The average time to complete each 3D scan was less than 5 seconds per attempt, with fascial plane blocks requiring twice the amount of time to complete. All the nerve blocks provided effective postoperative analgesia without complications. The 3D images were successfully captured in all patients.

          Conclusions

          The 3D images provide clinicians with valuable information on the anatomical boundaries of the injectate that can further direct needle direction and placement of local anesthetic to achieve visual confidence of anesthetic spread.

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          Most cited references19

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          Hand-held point of care ultrasound probes – the new generation of POCUS

          Recent advances in ultrasound technology have made ultrasound equipment more versatile, portable and accessible than ever. Modern hand-held, ultra-portable ultrasound devices have been developed by multiple companies and are contributing to make bedside ultrasound evaluation a practice available to all physicians. The significance of making point-of-care ultrasound a common practice that all physicians can eventually use in the evaluation of their patients is changing the way medicine is practiced, allowing physicians to quickly obtain valuable information to complement the traditional physical exam. Despite the proven benefits of using bedside ultrasound imaging as a part of the patient evaluation and for procedure guidance, adoption of this technology is still not widespread among anesthesiology clinicians, nor is there uniform teaching of ultrasound skills to anesthesia residents and faculty. Among obstacles that have been identified as precluding achievement of the goal of widespread utilization of POCUS among anesthesia professionals and trainees is the availability of equipment for all physicians when it is needed and lack of instructor supervision for trainees who desire to use ultrasound but do not always have an instructor knowledgeable in POCUS with them when an US exam is warranted. We analyze the characteristics, advantages and limitations of available ultra-portable, hand-held ultrasound devices, with a focus on the Butterfly IQ pocket-probe, which is available at our institution, and how some of its features, like the capacity to emulate multiple transducers and its cloud-sharing and teleguidance technology, may contribute to increase the availability and utilization of POCUS by anesthesia clinicians.
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            The spread of injectate during saphenous nerve block at the adductor canal: a cadaver study.

            The spread of injectate during a saphenous nerve block at the adductor canal has not been clearly described.
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              Anatomical basis of fascial plane blocks.

              Fascial plane blocks (FPBs) are regional anesthesia techniques in which the space ("plane") between two discrete fascial layers is the target of needle insertion and injection. Analgesia is primarily achieved by local anesthetic spread to nerves traveling within this plane and adjacent tissues. This narrative review discusses key fundamental anatomical concepts relevant to FPBs, with a focus on blocks of the torso. Fascia, in this context, refers to any sheet of connective tissue that encloses or separates muscles and internal organs. The basic composition of fascia is a latticework of collagen fibers filled with a hydrated glycosaminoglycan matrix and infiltrated by adipocytes and fibroblasts; fluid can cross this by diffusion but not bulk flow. The plane between fascial layers is filled with a similar fat-glycosaminoglycan matric and provides gliding and cushioning between structures, as well as a pathway for nerves and vessels. The planes between the various muscle layers of the thorax, abdomen, and paraspinal area close to the thoracic paravertebral space and vertebral canal, are popular targets for ultrasound-guided local anesthetic injection. The pertinent musculofascial anatomy of these regions, together with the nerves involved in somatic and visceral innervation, are summarized. This knowledge will aid not only sonographic identification of landmarks and block performance, but also understanding of the potential pathways and barriers for spread of local anesthetic. It is also critical as the basis for further exploration and refinement of FPBs, with an emphasis on improving their clinical utility, efficacy, and safety.
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                Author and article information

                Contributors
                Journal
                Anesth Pain Med
                Anesth Pain Med
                10.5812/aapm
                Brieflands
                Anesthesiology and Pain Medicine
                Brieflands
                2228-7523
                2228-7531
                04 March 2023
                April 2023
                : 13
                : 2
                : e134797
                Affiliations
                [1 ]The Department of Anesthesiology, the Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States of America
                Author notes
                [* ]Corresponding Author: The Department of Anesthesiology, the Warren Alpert Medical School, Brown University, 593 Eddy Street, Davol #129, Providence, Rhode Island, United States of America. Email: mark.kendall@ 123456lifespan.org
                Author information
                https://orcid.org/0000-0002-0862-9589
                https://orcid.org/0000-0001-5641-8674
                Article
                10.5812/aapm-134797
                10389033
                76a1ac8d-f23b-4612-a9be-c8e18f31db17
                Copyright © 2023, Author(s)

                This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

                History
                : 15 January 2023
                : 28 January 2023
                : 03 February 2023
                Categories
                Research Article

                point-of-care ultrasound,three-dimensional imaging,peripheral nerve blocks,fascial plane blocks

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