A scoping review of the evidence for teaching ultrasound-guided regional anesthesia.

A scoping review was performed to assess published evidence regarding how best to teach ultrasound-guided regional anesthesia (UGRA). The literature search yielded 205 articles, of which 35 met the inclusion criteria. Current literature on the topic can be divided into 3 main themes: the development of motor skills, learning and teaching sonoanatomy, and understanding of the requirements for establishing a UGRA education program and evaluation. We discuss the current status and future direction of research on UGRA training.

Real-time evaluation of diffusion of the local anesthetic solution during peribulbar block using ultrasound imaging and clinical correlates of diffusion.

BACKGROUND AND OBJECTIVES: The aims of this prospective observational study were to assess the incidence of intraconal spread during peribulbar (extraconal) anesthesia by real-time ultrasound imaging of the retro-orbital compartment and to determine whether a complete sensory and motor block (with akinesia) of the eye is directly related to the intraconal spread. METHODS: Ultrasound imaging was performed in 100 patients who underwent a surgical procedure on the posterior segment of the eye. All patients received a peribulbar block using the inferolateral approach. Once the needle was in place, a linear ultrasound transducer was placed over the eyelid and the spread of local anesthetics was assessed during the injection (real time). Akinesia was assessed by a blinded observer 10 minutes after block placement. The incidence of intraconal spread and its correlation with a complete akinesia was measured. RESULTS: The overall block failure rate was 28% in terms of akinesia, and the rate of rescue blocks was 20%. Clear intraconal spread during injection of the local anesthetic mixture could be detected with ultrasound imaging in 61 of 100 patients. The positive predictive value for successful block when intraconal spread was detected was 98% (95% confidence interval, 91%-100%). The association between clear and no evidence of intraconal spread and effective block was statistically significant (χ test, P < 0.001). CONCLUSIONS: Ultrasound imaging provides information of local anesthetic spread within the retro-orbital space, which might assist in the prediction of block success.

Pulsed radiofrequency under ultrasound guidance for persistent stump-neuroma pain.

Limb amputation is a leading cause of pain and disability. Limb amputation can be associated with a myriad of symptoms, including phantom limb sensation, phantom limb pain, and stump pain. Treatment of phantom limb pain and stump pain, remains difficult, therefore optimal management must include a multidisciplinary approach. This case report describes the use of ultrasound for diagnosis and successful management, of persistent stump-neuroma pain, using pulsed radiofrequency ablation.