Lung Ultrasound for the Regional Anesthesiologist and Acute Pain Specialist

Abstract

In this article, we discuss the emerging role of lung point-of-care ultrasonography for regional anesthesiologists and pain management specialists. Lung ultrasonography is a well-established clinical tool that is used on a routine basis in emergency rooms and critical care units internationally to evaluate patients with respiratory distress; however, its benefits to the regional anesthesiologist and pain specialist are not as well known and are practiced less frequently. This review article covers the clinical evidence in support of lung point-of-care ultrasonography as a rapid and superior tool to traditional imaging modalities such as chest radiography and fluoroscopy. As anesthesiologists routinely perform nerve blocks that put patients at potential risk of complications such as pneumothorax or diaphragmatic paresis, it is important to understand how to use lung ultrasonography to evaluate for these conditions, as well as to differentiate between other potential causes of respiratory distress, such as interstitial syndrome and pleural effusions. This article describes the normal and pathological findings that can be used to quickly and confidently evaluate a patient for these conditions.

The sound of air: point-of-care lung ultrasound in perioperative medicine

“…The presence of the clavicles makes this area less accessible for imaging, thus increasing the possibility of missing a small pneumothorax. 4,13,[20][21][22] Step 2 PROBE SELECTION Visualization of the pleural line is key. Therefore, although the pleural line is seen with both low-and highfrequency probes, a high-frequency (typically 13-6 MHz) linear probe is preferred because of the higher resolution.…”

“…19 The clinical context and specific sonographic findings (e.g., B line distribution, B line density, gravitydependent vs -independent pattern, associated changes in lung sliding and pulse, associated pleural line and subpleural abnormalities, presence of fluid or air bronchograms) can be sought to narrow the differential diagnosis and increase specificity. 4,6,16,22 The evidence Since the first publication correlating B lines and diseases affecting lung interstitium, 1 B lines have been consistently found to be useful and accurate in the diagnosis and monitoring of several lung conditions including inflammatory diseases such as acute respiratory distress syndrome (ARDS), 16 lung contusion, 46 lung infections, 47,48 and connective-tissue disorders/lung fibrosis. 49 Further, several observational studies and a recent meta-analysis suggest higher accuracy of LUS for the diagnosis of heart failure than routine clinical workup, including chest radiography and natriuretic peptides.…”

American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part I: clinical indications

“…4 Based on these recommendations, there exist guidelines for training, competency and credentialing in POCUS in emergency medicine 5 and critical care medicine, 6 7 and there is currently a work product for POCUS available through the American Society of Anesthesiologists (ASA). 8 Despite the availability of significant resources in the form of numerous live courses 9 and an educational review series on POCUS, [10][11][12][13][14][15] no specific guidelines or recommendations exist on the use of POCUS for regional anesthesiologists and pain physicians. Given ASRA's early leadership in providing recommendations for procedural-based bedside ultrasound in the form of ultrasound-guided regional anesthesia and ultrasound-guided interventional pain procedures, there was a call to address the need for formal POCUS recommendations.…”

Ultrasound applications for regional anaesthetists – thinking outside the box

“…Compelling evidence has emerged in support of lung pointof-care ultrasonography as a rapid and superior tool to traditional imaging modalities such as chest radiography and fluoroscopy [14]. As nerve blocks put patients at potential risk of complications such as pneumothorax, it is important to understand how to use lung ultrasonography to evaluate for this condition.…”

“…As nerve blocks put patients at potential risk of complications such as pneumothorax, it is important to understand how to use lung ultrasonography to evaluate for this condition. In addition, it is highly desirable to differentiate between other potential causes of respiratory distress, such as interstitial syndrome and pleural effusions [14].…”