Ultrasound-Guided Pain Interventions - A Review of Techniques for Peripheral Nerves

Soneji, Neilesh; Peng, Philip

doi:10.3344/kjp.2013.26.2.111

Cited by 39 publications

(46 citation statements)

References 75 publications

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“…From there, they run adjacent and parallel to each other, going from deep inguinal canal to the superficial inguinal canal in the fascial plane between the internal oblique and the transversus abdominis [64]. They innervate the lateral lower abdominal wall.…”

Section: Iliohypogastric Nervesmentioning

confidence: 99%

“…The medial technique increases the chance of trauma to the esophagus and thyroidal arteries; therefore, we prefer a lateral in-plane approach which allows the needle to pass lateral and posterior to the carotid artery and anterior to Chassaignac's tubercle (Figure 10). The injectate is directed between the prevertebral fascia and the longus colli muscle [64]. Four milliliters of injectate may be adequate when directed with US [65].…”

Section: • Stellate Ganglion Blockmentioning

confidence: 99%

“…The abdominal muscle layers are identified under US after which the nerve is identified in the fascial plane between the internal oblique and transversus abdominus muscles [64]. The IL and IH nerves are usually found in close association and within 1.5 cm of the iliac crest but sometimes a stimulator needle is used with paresthesia in the groin as an endpoint to increase accuracy [64,67,69].…”

Section: Iliohypogastric Nervesmentioning

confidence: 99%

“…The genitofemoral (GF) nerve travels along or within the spermatic cord in males, and along the inguinal canal and the round ligament in females [67]. The IL, IH and GF nerves are routinely blocked for postorchiectomy pain or chronic pain related to urethral sling, appendectomy, nephrectomy and ureterectomy [64,68]. Injections of these nerves may be diagnostic or therapeutic.…”

Section: Iliohypogastric Nervesmentioning

confidence: 99%

“…From there the artery is traced cephalad until the spermatic cord is visualized in cross-section. Note is made to avoid the testicular artery as the medication is delivered within the spermatic cord and in the inguinal canal outside of the spermatic cord [64]. Epinephrine should never be used in this block due to its effects on the testicular artery [67].…”

Section: Iliohypogastric Nervesmentioning

confidence: 99%

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Ultrasound-Guided Interventional Procedures for Chronic Pain Management

et al. 2015

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Ultrasonography has multiple advantages over traditional radiologic imaging modalities when used for interventional procedures. It allows improved visualization of the anatomy while avoiding ionizing radiation and risks associated with contrast use. It has proved superiority at accuracy of delivery and procedural effectiveness over blind procedures when used in association with interventional pain procedures. Although limited in its ability to see through bony structures, ultrasound has utility in visualizing soft tissues and vascular structures in anatomic regions of interest resulting in increased use for posterior neuraxial, periaxial, peripheral nerve and joint-related structures. Current evidence for use in these settings is presented here. In some cases, optimal utility may be improved by combining ultrasonography with other imaging modalities. KEYWORDS• chronic pain management Advantages of ultrasound imagingInterventional pain procedures were traditionally performed under fluoroscopic (FS), computed tomography (CT) or MRI guidance. The use of ultrasound (US) to perform injections for chronic pain has significantly increased in the past decade [1,2]. This increase is attributed to its multiple advantages over other imaging modalities including ease of performance, absence of ionizing radiation, better visualization of soft tissue (i.e., muscle, ligament) and blood vessels, real time visualization of needle advancement and, at times, the ability to observe the spread of injectate [3]. US Practice points• Use of ultrasound in medicine has grown with smaller size equipment, increased portability and decreased cost.• Ultrasound has multiple advantages over radiographic imaging when used for interventional pain procedures.• Sonography is useful for medial branch blocks and intra-articular facet blocks in the cervical and lumbar spine but there is little evidence to support its use in the thoracic spine.• Ultrasonography is limited in utility for many types of axial injections because of bony and acoustic shadowing artifact but it does show some promise with transforaminal epidurals or selective nerve root blocks.• Ultrasound guidance is effective in preventing soft tissue and vascular injury in stellate ganglion blocks compared with blind techniques. Soft tissue and vascular anomalies can be identified that fluoroscopic technique will miss.• Ultrasound improves accuracy and efficacy in ilioinguinal, iliohypogastric and genitofemoral blocks for inguinal and testicular pain.• Lateral femoral cutaneous nerve injections are more accurate under ultrasound guidance, especially given the anatomic variation the nerve exhibits in cadaver dissections.• Injections into the knee, shoulder and hip joints are more successful when performed using ultrasound.For reprint orders, please contact: reprints@futuremedicine.com

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Section: Iliohypogastric Nervesmentioning

confidence: 99%

Section: • Stellate Ganglion Blockmentioning

confidence: 99%