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Az alsó végtagi perifériás idegblokádok
Transcript of Az alsó végtagi perifériás idegblokádok
KMOK KAIBO B.BRAUN AESCULAP ACADEMY 2010.04.22.Budapest Anatomia Indicatio Anaesthesia UH technikák módszerek Elönyök-hátrányok Mások mit mondanak? UH guided nerve block rating scale
Visualisation of nerve structures
1 easy 2 intermediate 3 difficult
Visualisation of identifying featuures (1-3)
Technical performance (1-3)
Risk of complications from associated structures
1 low 2 intermediate 3 high
4-6 Basic (cervical, ISB, ax, fem, saph, ankle
7-9 Intermediate (supra-infra clav, obturator, sciaitic)
10-12 Advanced (deep cervical, TPB)
Peter Marhofer Oxford Univ.Press, 2008 Methods of improving US needling techniques
Simple practical techniques
Larger needles are more easily visualized than smaller ones.
Directing the ultrasound beam perpendicular to the needle rather than parallel to it.
Filling the needle with a clear solution rather than air.
Introducing the needle with its bevel either pointing towards the ultrasound probe or away from it. The relatively rougher bevel results in more ultrasound scatter, enhancing the tip.
Tissue movement: introduce the needle in a short “in-and-out, side-to-side” motion
Hydrolocation: injecting a small amount of a clear solution can enhance the visibility of the needle tip.
The use of special needles
Special needles with increased echogenicity
Certain needles have a stylet with a piezoelectric crystal at its tip to receive the ultrasound beam. The stylet is wired to the ultrasound machine, which is programmed to display the piezoelectric tip as bright red on its screen.