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Director: Peripheral nerve Analgesia Director: regional anesthesia Fellowship Section Head: Orthopedic Anesthesia Cleveland Clinic . Loran Mounir Soliman M.D. Do W e Need Ultrasound Guidance for Regional Anesthesia ??. Goals and Objectives. 1. 3. 2.
Director: regional anesthesia Fellowship
Section Head: Orthopedic Anesthesia
Loran Mounir Soliman M.DDo We Need Ultrasound Guidancefor Regional Anesthesia??
Why to use Ultrasound versus Not??
Is there any evidence?
Do we need Ultrasound for regional Anesthesia??
Real- time pictures
Seeing is believing.
Better picture enhansmentsoftwares
Needle Guiding softwares
Better sonographic needles
Easy to use interface
Long history of experience and safety of conventionaltechniques
Need to reducecost & expenses
Did UGRA resulted in…….
Better Success rate
Post Operative Neurologic Symptoms (PONSs)
Local Anesthetic Systemic Toxicity (LAST)
1. Kirvela O, Svedstrom E, Lundbom N. Ultrasonic guidance of lumbar sympathetic and celiac plexus block: a new technique. Reg Anesth. 1992;17:43Y46. 2. Ootaki C, Hayashi H, Amano M. Ultrasound-guided infraclavicular brachial plexus block: an alternative technique to landmark-guided approaches. Reg Anesth Pain Med. 2000;25:600Y604. 3. Kapral S, Krafft P, Eibenberger K, et al. Ultrasound-guided supraclavicular approach for regional anesthesia of the brachial plexus. Anesth Analg. 1994;78:507Y513. 4. Ting PL, Sivagnanaratnam V. Ultrasonographic study of the spread of local anaesthetic during axillary brachial plexus block. Br J Anaesth. 1989;63:326Y329.
Succesfull Block equals Surgical anesthesia
(No GA, Spinal nor suplementation blocks)
No significant difference in success rate of US guided blocks
Other benefits of Ultrasound included: faster onset, longer duration and higher patient satisfaction.
No single report suggesting that Ultrasound is inferior to other techniques or carry a higher risk.
US faster onset and higher success rate
Ultrasound is superior than landmarks in determination of the midline, identification of the level and the depth from the skin
Ultrasound is better than Anatomical method but inferior to radiology imaging
Trend toward faster blocks and lower volumes
There are no RCT data that unequivocally supportsuperior safety outcomes consequent to the use of UGRACase reports emphasize that absolute elimination of these seriouscomplications has not occurred.
Seizure 0.8%(one case)
Cardiac toxicity 0 cases