Real-Time Three-Dimensional Ultrasound-Assisted Axillary Plexus Block Defines Soft Tissue Planes

Abstract

Two-dimensional (2D) ultrasound is commonly used for regional block of the axillary brachial plexus. In this technical case report, we described a real-time three-dimensional (3D) ultrasound-guided axillary block. The difference between 2D and 3D ultrasound is similar to the difference between plain radiograph and computer tomography. Unlike 2D ultrasound that captures a planar image, 3D ultrasound technology acquires a 3D volume of information that enables multiple planes of view by manipulating the image without movement of the ultrasound probe. Observation of the brachial plexus in cross-section demonstrated distinct linear hyperechoic tissue structures (loose connective tissue) that initially inhibited the flow of the local anesthesia. After completion of the injection, we were able to visualize the influence of arterial pulsation on the spread of the local anesthesia. Possible advantages of this novel technology over current 2D methods are wider image volume and the capability to manipulate the planes of the image without moving the probe.

Recognition of local anesthetic maldistribution in axillary brachial plexus block guided by ultrasound and nerve stimulation

“…The brachial plexus is contained within a membranous sheath that interdigitates with the individual nerves and may potentially sequester local anesthetic solution, preventing spread to all nerves [6,13,14]. In the case presented, peripheral nerve stimulation was misleading because one of these fascial membranes, tightly wedged between the peripheral nerve and the stimulating needle tip, allowed current to pass with little impedance.…”

Three-dimensional ultrasound imaging

“…In 2007, they described placement of sciatic popliteal catheter assisted by realtime 3-D ultrasound. Subsequently, the same group published on utilization of this technology for a variety of other nerve blocks, including axillary plexus block and interscalene and infraclavicular brachial plexus catheter placement [1,9,10]. One of the advantages observed with their utilized equipment (3D Ultrasound System IE-33/IU 22; Philips Medical Systems, Andover, Massachusetts, USA) was the ability to manipulate the image and visualize different planes without the need to reposition the ultrasound probe.…”

The new technological trends in ultrasound-guided regional anesthesia

“…Authors distinguished linear hyperechoic connective tissue structures limiting initially the spread of the local anesthetic solution. After completing injection, the influence of arterial pulsation on the local anesthetic spread was visualized [22]. In other case reports, four-dimensional US has been used to observe local anesthetic distribution during the placement of a nerve block at the sciatic, and at interscalene level [23,24].…”