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1.  Review Articles
Ultrasound-guided Subcostal Transversus Abdominis Plane Block
Niraj G, A Kelkar, R Powell
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:9-12]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1002 | FREE

Ultrasound-guided subcostal transversus abdominis plane block is a recently described regional anaesthetic technique for providing postoperative analgesia after upper abdominal surgery. Use of subcostal TAP catheters holds considerable promise on account of its relative simplicity, efficacy and safety profile. This article reviews the current literature on this technique and reflects on personal experience.
Keywords: Subcostal TAP block, TAP catheter, ultrasound-guided.

2.  Special Articles
Needle and Transducer Manipulation: The Art of Ultrasound-guided Regional Anaesthesia
Ki Jinn Chin
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:27-32]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1006 | FREE

The safe and successful performance of ultrasound-guided regional anaesthesia (USGRA) requires both a detailed knowledge of the anatomy and sonoanatomy relevant to the block, and the ability to appreciate where the needle tip is at all times. The latter is dependent on skilful needle and transducer manipulation and can be the most challenging aspect of USGRA, particularly for novices. Visualising the needle tip on ultrasound requires that it be aligned with the ultrasound beam; however even when alignment is achieved, the physical characteristics of the needle and the limitations of ultrasound technology may hinder visibility. This article describes several strategies for needle and transducer manipulation designed to assist the practitioner with locating the needle tip and guiding it to the desired target.
Keywords: Ultrasound, regional anaesthesia, peripheral nerve block, needle visibility.

3.  Special Articles
Basic Physics of Ultrasound in Transesophageal Echocardiography
Mary Korula, Ravi Hebballi
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:33-38]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1007 | FREE

The Transoesophageal echocardiography is proving a valuable tool to evaluate, diagnose and treat patients in perioperative and intensive care settings. This was previously limited to only cardiologist but now is accessible to most of us, especially in perioperative care. This article describes the basic physics of ultrasound involved in echocardiography. Understanding the basic physics will help the reader to obtain and interpret the images more effectively.
Keywords: Transoesophageal echocardiography, ultrasound, Doppler, artifact, perioperative care, intensive care.

4.  Pictorial Review
Ultrasound-guided Supraclavicular Brachial Plexus Block
Faisal Rasool, Armin Bartsch, Aamer B Ahmed, Atul Gaur
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:39-48]
Full Text HTML | Full Text PDF | DOI : 10.5005/jp-journals-10014-1008 | FREE

5.  Original Articles
Ultrasound-guided Brachial Plexus Block at the Supraclavicular Level: A New Parasagittal Approach
Adrian Searle, Niraj G
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:19-22]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1004 | FREE

The study evaluates a new approach to ultrasound-guided supraclavicular brachial plexus block using a supraclavicular parasagittal approach. Sixty outpatients scheduled for hand surgery were given brachial plexus block utilising the new approach. Time taken for block procedure was short and onset time for sensory block was rapid, using a low volume of local anaesthetic agent, with the volume decided by the operator under direct visualisation of spread. The nerve stimulator was not used. Only 10% required limited peripheral supplementation. Complications were limited to Horner’s syndrome in four patients and small vessel puncture in one.
Keywords: Ultrasound, supraclavicular, regional anaesthesia, brachial plexus.

6.  Case Study
Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) as a Diagnostic Tool for the Evaluation of Mediastinal Pathology: The Leicester Experience
Pranab Haldar, Abdul Nasimudeen, Andrew Medford, Jonathan Bennett, Sanjay Agrawal
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:49-53]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1009 | FREE

Endobronchial ultrasound (EBUS) is a recently developed and evolving tool that enables sampling of mediastinal lymph nodes and other peribronchial tissues using real-time ultrasonic image guidance. Studies to date report superior diagnostic specificity and sensitivity with EBUS, compared with conventional transbronchial needle aspiration performed without image guidance. Furthermore, the specificity of EBUS for malignant mediastinal lymph node disease is comparable to the gold standard of surgical mediastinoscopy. As a clinical tool, EBUS is a minimally invasive, out-patient procedure that is fast transforming diagnostic pathways for mediastinal pathology. In this article, we summarise the technical aspects of EBUS and present our local clinical experience of 18 months.
Keywords: Bronchoscopy, endobronchial ultrasound, mediastinal lymph node, lung cancer, transbronchial needle aspiration.

7.  Original Articles
Ultrasound-guided Thoracic Paravertebral Block for Postoperative Pain Treatment after Thoracoscopic Surgery
Abdelazeem El-Dawlatly, Waseem Hajjar, Sami A Alnassar, Tariq A Alzahrani Mohamed Bilal Delvi, Abu Bakr Omar
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:23-26]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1005 | FREE

Background: Acute pain management following thoracoscopic surgery (TS) presents challenges for anaesthesiologists. In this manuscript we compared the efficacy of three different techniques for postoperative pain treatment following TS.
Methods: Thirty patients scheduled to undergo TS under general anaesthesia were randomly allocated into 3 groups (10 patients each group) according to pain relief modality to be used postoperatively.
Group A: Patients received ultrasound guided thoracic paravertebral block (USGTPV) with bupivacaine 0.5%, consisting of a 10 ml bolus and continuous infusion of bupivacaine 0.0625%, 4 to 6 ml/hr. Rescue analgesia using patient controlled IV analgesia (PCA) was available, using 1 mg bolus Morphine with a 6 minute lock-out.
Group B: Patients received patient controlled IV analgesia alone, morphine 1 mg/ml with lock out time of 6 minutes postoperatively.
Group C: Patients received interpleural spray of 0.5% bupivacaine (20 ml) at the end of surgery followed by PCA morphine at same setting for groups A and B. Postoperative pain was assessed using the 11-point numeric rating score (NRS) at 7 different intervals (immediately on admission to PACU, every 2 hours for the next 8 hours then at 12 and at 24 hours postoperatively). Pain was assessed at rest, during deep inspiration and whilst coughing. Total dosages of morphine used in the first 24 hours postoperatively were recorded for each group. Non-Parametric Kruskal-Wallis Test was used for comparisons between the three groups and Spearman’s correlation coefficient (rs) was used to identify the correlations between morphine dose and pain at different conditions in the three groups. Mann-Whitney Test was used for comparisons within each group where P values < 0.05 were considered significant.
Results: The median values (range) of NRS at rest were 1.5 (0-30), 4 (3-5) and 2 (1-4) for groups A, B and C respectively with significant differences (P < 0.05). The median values of NRS at deep inspiration and on coughing showed nonsignificant difference between the three groups (P > 0.05).
The median values (range) of morphine consumption in the first 24 hours were 2 (0-30), 26.5 (10-47) and 10 (4-15) mg in groups A, B and C respectively with significant differences (P < 0.0001).
Conclusions: Compared to interpleural bupivacaine or conventional systemic analgesics with morphine, USGTPV block with bupivacaine provided superior postoperative analgesia following thoracoscopic surgery.
Keywords: Thoracoscopic surgery, interpleural analgesia, ultrasound-guided thoracic paravertebral block.

8.  Original Articles
Continuous Block of the Articular Branches of the Femoral Nerve as a Novel Technique for Pain Control after Hip Arthroplasty
Thomas M Hemmerling, Carmelo Minardi, Luca Bevilacqua, Cedrick Zaouter Avinash Sinha, Michael Tanzer
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:13-17]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1003 | FREE

Background: We present a novel continuous block of the articular branches of the femoral nerve (ABFN) for analgesia after hip arthroplasty.
Methods: In this prospective audit, twenty-five patients underwent hip arthroplasty performed by the same surgeon (MT) under spinal anaesthesia performed by the same anaesthesiologist (TH) using 10 to 15 mg of Bupivacaine 0.5%. Before February 2008, pain management after hip arthroplasty was provided solely using patient-controlled analgesia (PCA) with morphine (N = 10; PCA-group). After February 2008, block of ABFN with Ropivacaine 2% at 6 to 8 mL/h for 24 hours was additionally performed immediately after surgery (N = 15; PCA + ABFN-group) in the postoperative care unit (PACU). Pain scores were compared using a numeric pain score (NPS) at discharge from the PACU, 24 hours after surgery; total morphine consumption for the first 12 and 24 hours after surgery was compared. Data presented as means ± SD and compared using Mann-Whitney rank sum test or Fisher test. P < 0.05 was considered to show a statistically significant difference.
Results: Patients’ demographic data were not significantly different. Pain scores were significantly lower in the PCA + ABFN-group (1 ± 1.2 vs 3.5 ± 2.9 in the PCA-group) at the time of discharge from the PACU, but did not differ significantly 24 hours after surgery. Morphine consumption both at 12 hours (14.7 ± 7.4 mg vs 36.8 ± 13.3) and 24 hours (25.7 ± 14 mg vs 52.5 ± 26.8) after surgery was significantly lower in the PCA + ABFN-group.
Discussion: Blocking the ABFN combined with PCA morphine provides superior analgesia after hip arthroplasty than PCA morphine alone.
Keywords: Ultrasound, regional anaesthesia, peripheral nerve block, hip arthroplasty.

9.  Review Articles
Ultrasound for Paediatric Neuraxial Blocks
Steve Roberts, Sanaulla K Syed
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:1-8]
Full Text HTML | Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10014-1001 | FREE

Ultrasound (US) is becoming an important adjunct in regional anaesthesia. By imaging nerves and other anatomical structures the safety and efficacy profile of regional anaesthesia and analgesia has enhanced. Cork et al1 were the first to visualise the neuraxial structures by US, but until recently US was not used in inserting and visualising epidural catheters. As the vertebral column of infants is still in the process of ossification and the depth of the neuraxial structures is less than in adults, it is reasonable to assume that conditions for visualising neuraxial structures is a function of age. Cranial advancement in US imaging of spine is associated with a reduction in the acoustic window shadow ratio, nevertheless US imaging is useful in measuring the depth to epidural space from skin, planning the needle trajectory and deciding on the puncture point. Hence, the younger the child the better the conditions for imaging neuraxial structures. This review focuses on the use of ultrasound for neuraxial imaging in the paediatric population.
Keywords: Ultrasound, epidural catheter, paediatric, neuraxial, anaesthesia, analgesia.

10.  Comments and Commentaries
Ultrasound-guided Regional Anaesthesia: A Step Forward
Pawan Kumar, Satya Francis
[Year:2010] [Month:January-April] [Volume:1 ] [Number:1] [Pages:77] [Pages No:55-58]
Full Text HTML | Full Text PDF | DOI : 10.5005/jp-journals-10014-1010 | FREE


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