Ultrasound Skills in Lower Extremity Traumatology and Orthopedics – Regional Anesthesia and Beyond

Abstract

SUMMARYDuring the last two decades ultrasound guidance has been established as an invaluable tool for performing peripheral nerve blocks. Ultrasound guidance reduces block performance time, volume of local anesthetic, risk of intravascular injection and need for opioid rescue analgesia compared to landmark based and neurostimulator guided techniques. The use of ultrasound guidance must not be understood as a surrogate to, but should complement a thorough understanding of anatomy. The purpose of this overview is to present ultrasound guided techniques for performing basic lower extremity blocks, as well as to discuss more recent trends in providing regional analgesia for patients undergoing lower extremity surgery.

Transposition of the superficial femoral artery combined with ultrasound-guided returning-venous cannulation as a last resort for vascular access in a multi-complicated hemodialysis patient

“…The femoral nerve has sensory branches that innervate the anteromedial thigh and the medial lower leg (the saphenous nerve), and motor branches that innervate the SM and the quadriceps femoris muscle; the lateral femoral cutaneous nerve is a pure sensory nerve innervating the anterolateral thigh. 8,9 We performed US-guided effective blockade of these two nerves to implant an arteriovenous graft in the thigh between the SFA and the femoral vein in a loop configuration. Although the efficiency of regional anesthesia may vary with each patient’s physical status and the sensory range of the blocked nerves, this technique could constitute an additional approach for anesthesia in this superficialization surgery.…”