《Needle Visualization in Ultrasound-Guided Reginal Anesthesia》.pdf

Review Article Needle Visualization in Ultrasound-Guided Regional Anesthesia: Challenges and Solutions Ki Jinn Chin, M.B.B.S., F.A.N.Z.C.A., M. Med., F.R.C.P.C., Anahi Perlas, M.D., F.R.C.P.C., Vincent W. S. Chan, M.D., F.R.C.P.C., and Richard Brull, M.D., F.R.C.P.C. Needle visualization is important for safe and successful ultrasound-guided peripheral nerve block. However, accurate and consistent visualization of the needle tip can be difficult to achieve. This review article describes many of the challenges affecting needle visualization, summarizes the relevant literature on ultrasound imaging of needles, and offers practical strategies for improving needle tip visibility. Finally, future directions for research and development are suggested. Reg Anesth Pain Med 2008;33:532-544. Key Words: Needle visualization, Peripheral nerve block, Regional anesthesia, Ultrasound. he foremost advantage of ultrasound (US)- This review article describes many of the chal- Tguided peripheral nerve block (PNB) is the ability lenges in needle visualization, summarizes the rel- to visualize both anatomical structures of interest as evant literature on ultrasound imaging of needles, well as the advancing block needle. Ideally, US guid- and offers practical strategies for improving needle ance should translate into greater efficacy, by ensur- tip visibility. ing accurate deposition and spread of local anesthetic around the target nerve; and improved safety, by Methods avoiding unintentional intraneural and intravascular We performed a literature search of the MEDLINE puncture and injection. While the identification of database from January 1960 to January 2008 us- rele