Article de synthèse: considérations anatomiques pour l’échoguidage lors de l’anesthésie régionale du cou et des membres supérieurs

Abstract

Purpose The purpose of this narrative review is to describe an anatomical approach for residents-in-training and anesthesiologists who are learning techniques of ultrasound-guided regional anesthesia of the neck and upper limb Sources Relevant articles relating anatomy and anatomical variation to the emerging practice of ultrasoundguided regional anesthesia for the neck and upper limb were sourced via both Medline and PubMed databases. Also, our approach to teaching ultrasound technique has developed from using anatomical resources and cadaveric workshops. This approach emphasizes precise image acquisition, a detailed knowledge of anatomy and anatomical variations, and, importantly, visual interpretation of sonographic landmarks based on pattern recognition when interpreting sonograms. Principal findings Typical sonographic patterns orient the examiner to nerve position, which is necessary for executing successful regional anesthesia of the neck and upper limb. Only by understanding the typical anatomical arrangement can the examiner then visually interpret any individual anatomical variation that may occur. Conclusion Simple sonographic anatomical patterns can provide a strategy to correctly locate nerves when performing ultrasound-guided cervical and brachial plexus anesthesia. RésuméObjectif L'objectif de ce compte-rendu narratif est de de´crire une approche anatomique destine´e aux re´sidents en formation et aux anesthe´siologistes qui apprennent les techniques d'anesthe´sie re´gionale du cou et des membres supe´rieurs par e´choguidage. Sources Les articles pertinents traitant de l'anatomie et des variations anatomiques dans la pratique e´mergente de l'anesthe´sie re´gionale du cou et des membres supe´rieurs par e´choguidage ont e´te´tire´s des bases de donne´es Medline et PubMed. De plus, notre approche de l'enseignement des techniques e´choguide´es a e´volue´graˆce au recours ad es ressources anatomiques et des ateliers sur des cadavres. Cette approche met l'accent sur l'obtention d'images pre´cises, une connaissance de´taille´e de l'anatomie et des variations anatomiques et, composante importante, l'interpre´tation visuelle de points de repe`res e´chographiques selon une reconnaissance des configurations lors de l'interpre´tation des e´chogrammes. Constatations principales Les configurations e´chog-raphiques typiques fournissent des informations al 'examinateur quant a`la position des nerfs, ce qui est ne´cessaire a`la re´alisation d'une anesthe´sie re´gionale du cou et des membres supe´rieurs re´ussie. Il faut que l'examinateur comprenne la disposition anatomique typique pour ensuite pouvoir interpre´ter de façon visuelle les variations anatomiques individuelles potentielles.

Value of an Electronic Tutorial for Image Interpretation in Ultrasound-Guided Regional Anesthesia

“…Application of simple sonographic anatomical patterns can provide a strategy to correctly locate nerves when performing ultrasoundguided cervical and brachial plexus anesthesia. 15 This complex visual recognition process should be trained repeatedly by putting cross-section anatomy images, simplified drawings, and defined ultrasound images together. 1 Repetitive training sessions are essential to reinforce learning and acquire procedural skills, as part of a deliberate practice model.…”

Characteristic Ultrasound Feature of Traumatic Neuromas After Neck Dissection: Direct Continuity with the Cervical Plexus

“…The cervical plexus arises between the anterior and posterior tubercles of the transverse process and then moves posterolaterally in a downward direction. The branches of the cervical plexus are located deep inside the sternocleidomastoid muscle, between the longus capitis and scalene medius muscles in upper cervical levels or between the scalene anterior and scalene medius muscles in lower cervical levels (21)(22)(23). By positioning the US probe in an oblique plane, that is, in the postero-infero-lateral direction, this anatomic relationship makes determination of the direct continuity of traumatic neuroma with branches of the cervical plexus more feasible (Fig.…”

“…If the involved nerve was well visualized, its cervical level was determined by following it to the groove, between the anterior and posterior tubercles, of the transverse process. The transverse process of the C7 vertebra was used as an anatomic landmark to assess the cervical level (21,22). From the appearance of involved nerves on US, we categorized each as an injured nerve terminating in a traumatic neuroma with bulbous enlargement of the nerve end, or as a nondisrupted nerve passing through the traumatic neuroma with fusiform enlargement.…”

Applications of Ultrasonography in ENT: Airway Assessment and Nerve Blockade

“…39 Several ultrasound-guided approaches to the cervical plexus have been described. 2 An injection into the longus capitis at the level of C4 has shown to achieve blockade of the C2 to C5 nerve roots (located in a groove between the longus capitis and scalenus medius muscles) and of the sympathetic trunk (located on the anteromedial surface of the longus capitis muscle). 40 After performing an anatomic study in 28 cadavers, Usui and colleagues 40 determined that the injection position was localized to the site where a cranially directed ultrasound scan, initially focused on the scalenus anterior and longus capitis muscle at the level of C6, captured the point where the scalenus anterior muscle tapered off at either C3 or C4.…”

“…The roots appear posterior to the anterior tubercles using a transverse view, but posterior to the vertebral artery using a longitudinal plane. 2 Identification of the vertebral artery and transverse processes of C2 to C4 allows cervical plexus block posterior to the artery. 2,39 Scanning caudally from the mastoid process, the level of the C2 transverse process and nerve root are identified through recognition of the loop that the vertebral artery makes as it travels between the foramen of C2 and C1.…”