Atlas of Ultrasound-Guided Procedures in Interventional Pain Management

Atlas of Ultrasound- Guided Procedures in Interventional PainManagement

Foreword

Preface

Acknowledgments

Contents

Contributors

1: Imaging in Interventional Pain Management

Introduction

C-Arm FDCT

Ultrasound

Intra-Articular Injections

Trigger Point and Muscular Injections

Zygapophyseal and Medial Branch Blocks

Epidural Blocks

Sympathetic Blocks

Combined US and CT/Fluoroscopy

Conclusion

References

2: Basics of Ultrasound Imaging

Introduction

Basic Principles of B-Mode US

Generation of Ultrasound Pulses

Ultrasound Wavelength and Frequency

Ultrasound–Tissue Interaction

Recent Innovations in B-Mode Ultrasound

Conclusion

References

3: Essential Knobology for Ultrasound-Guided Regional Anesthesia and Interventional Pain Management

Introduction

Frequency and Probe Selection

Depth

Gain

Time Gain Compensation

Focus

Presets

Color Doppler

Power Doppler

Compound Imaging

Tissue Harmonic Imaging

Optimization Button

Freeze Button and Image Acquisition

References

4: How to Improve Needle Visibility

Introduction

Training and Phantom Simulation

Training with Adequate Mentorship

Phantoms

High-Fidelity Simulation

Combined Ultrasound and Flouroscopic Phantom Simulators

Procedural Needle-Related Visibility Factors

Basic Sonography and Needle Image Interpretation

Acoustic Impedance as the Basis for Procedure Needle Visualization

Size (Gauge) of the Procedure Needle and Its Echogenicity

The Skin Insertion Site Selected and Angle of Procedure Needle Passage

Echogenic Procedure Needles

Procedure Needle Tip

The Ultrasound Device and Procedure Needle Visibility

Ultrasound Imaging Artifacts and Procedure Needle Visibility

Impact of Various Sonographic Modes on Procedure Needle Visibility

Compound Spatial and Frequency Image Reconstruction Following Acoustic Beam Steering and Variable Frequency

Frequency of the Ultrasound Probe (AKA Depth) Acoustic Power and Gain

Time Gain Compensation and Harmonic Imaging

Brightness, Motion, and Doppler Modes

3D and 4D Ultrasound Imaging

Recent Advances in Ultrasound Imaging and Procedure Needle Visibility

Needle-Probe Alignment

Need for Procedure Needle and Ultrasound Probe Alignment

“In-Plane” and “Out-of-Plane” Needle Approach: Classical Probe-Needle Interpositions

Oblique Plane Needle Approach for Ultrasound-Guided Pain Management

Biplane Needle Imaging Approach for Ultrasound-Guided Pain Management

Mechanical and Optical Procedure Needle Guides

Advanced Procedure Needle Positioning Systems

The “ART” of Scanning for Better Procedure Needle Visualization

Ergonomics for Better Procedure Needle Visibility

Enhancement and Techniques to Improve Procedure Needle Localization

Basic Sonographic Effect of Enhancement

Enhancement with Priming, Insertion of Stylet or Guide Wire, and Vibration

Hydrolocalization of the Procedure Needle

Procedure Needle Visibility by Agitated Solutions or with Ultrasound Contrast Agents

Localization of the Procedure Needle Tip with the Aid of Nerve Stimulation

Summary

References

5: Spine Anatomy and Sonoanatomy for Pain Physicians

Introduction

Basic Spine Anatomy (Figures 5.1–5.13)

Cervical Spine

Thoracic Spine

Lumbar Spine

Sacrum

Sonoanatomy of the Cervical Spine

Superficial (Figures 5.14–5.21)

Deep (Figures 5.22–5.25)

Sonoanatomy of the Thoracic Spine

Superficial (Figures 5.26 and 5.27)

Deep (Figures 5.28 and 5.29)

Sonoanatomy of the Lumbar Spine

Superficial (Figures .5.30–5.33)

Deep (Figures 5.34–5.36)

Sonoanatomy of the Sacrum and Sacroiliac Joint

Superficial (Figures 5.37–5.40)

Deep (Figures 5.41 and 5.42)

6: Ultrasound-Guided Third Occipital Nerve and Cervical Medial Branch Nerve Blocks

Anatomy

Indications for Cervical Medial Branch Block

Why Ultrasound-Guided Facet Nerve Block? The Literature and Our Experience

Possible Advantages of Ultrasound for Cervical Facet Nerve Blocks

Limitations of Ultrasound

Ultrasound-Guided Technique for TON and Cervical Medial Branch Block

Scanning Before Injection

Identifying the Correct Level: Method 1

Identifying the correct Level: Method 2

Practical Performance of Block

Conclusion

References

7: Ultrasound-Guided Cervical Zygapophyseal (Facet) Intra-Articular Injection

Anatomy of the Cervical Facet Joints

Indications for Cervical Zygapophyseal Joint Intra-Articular Injection

Literature Review of Ultrasound-Guided Cervical Facet Injections

Ultrasound-Guided Technique for Cervical Facet Intra-Articular Injection

Lateral Approach

Posterior Approach

References

8: Ultrasound-Guided Cervical Nerve Root Block

Anatomy of Cervical Nerve Root

Indications

Limitations of the Fluoroscopy-Guided Techniques

Literature Review of Ultrasound-Guided Cervical Nerve Root Block

Sonoanatomy of the Cervical Spine and Identification of the Cervical Level

Ultrasound-Guided Technique for Cervical Selective Nerve Root Block

References

9: Ultrasound-Guided Thoracic Paravertebral Block

Introduction

Anatomy

Mechanism of Blockade

Techniques of TPVB

Ultrasound-Guided TPVB

Sonoanatomy Relevant for TPVB

Basic Considerations

Transverse Scan of the Thoracic Paravertebral Region

Sagittal Scan of the Thoracic Paravertebral Region

Techniques of USG TPVB

Transverse Scan with Short-Axis Needle Insertion (Technique 1)

Paramedian Oblique Sagittal Scan with In-Plane Needle Insertion (Technique 2)

Transverse Scan with In-Plane Needle Insertion or the Intercostal Approach to the TPVS (Technique 3)

Conclusion

References

10: Ultrasound-Guided Lumbar Zygapophysial (Facet) Nerve Block

Introduction

Anatomy

Literature Review

Scanning Technique

Injection Technique

Lumbar (L1–L4) Zygapophysial Medial Branch and L5 Dorsal Ramus Nerve Block

Limitations of Ultrasound-Guided Zygapophysial Nerve and Joint Injection

References

11: Ultrasound-Guided Lumbar Nerve Root (Periradicular) Injections

Introduction

Ultrasound-Guided Technique

Limitations of the Ultrasound-Guided Technique

References

12: Ultrasound-Guided Central Neuraxial Blocks

Introduction

History

Ultrasound Imaging of the Spine

Basic Considerations

Axis of Scan

Spinal Sonoanatomy

The Water-Based Spine Phantom

Ultrasound Imaging of the Sacrum

Ultrasound Imaging of the Lumbar Spine

Ultrasound Imaging of the Thoracic Spine

Ultrasound-Guided CNB

Caudal Epidural Injection

Lumbar Epidural Injection

Thoracic Epidural Injection

Spinal Injection

The Evidence

Education and Training

Conclusion

References

13: Ultrasound-Guided Caudal, Ganglion Impar, and Sacroiliac Joint Injections

Ultrasound-Guided Caudal Epidural Injections

Anatomy

Indications for Caudal Epidural Injection

Limitations of the Landmark “Blind” Technique

Literature Review of Ultrasound-Guided Caudal Epidural Injections

Ultrasound-Guided Caudal Injection Is Better than the “Blind” Technique

Ultrasound-Guided Technique for Caudal Epidural Injection

Limitations of the Ultrasound-Guided Technique

Ultrasound-Guided Ganglion Impar Block

Anatomy

Indications

Limitations of the Current Technique

Literature Review on Ultrasound-Guided Ganglion Impar Block

Technique of Ultrasound-Guided Ganglion Impar Block

Limitations of the Ultrasound-Guided Technique

Ultrasound-Guided Sacroiliac Joint Injection

Anatomy

Indications for SIJ Injection

Literature Review on Ultrasound-Guided SIJ Injection

Technique of Ultrasound-Guided SIJ Injection

Limitations of Ultrasound-Guided SIJ Injection

References

14: Ultrasound-Guided Transversus Abdominis Plane (TAP) Block

Introduction

Anatomy

The Classic Approach

Ultrasound-Guided Technique

Summary

References

15: Ultrasound-Guided Celiac Plexus Block and Neurolysis

Introduction

Anatomy of the Celiac Plexus

Current Techniques for Celiac Plexus Block

The Anterior Percutaneous Approach

Advantages of US-Guided Anterior Approach

Limitations of US-Guided Anterior Approach

Sonoanatomy of the Epigastrium and Relevant Structures

Percutaneous Ultrasound-Guided Celiac Plexus Block Technique

References

16: Ultrasound-Guided Blocks for Pelvic Pain

Introduction

Ilioinguinal, Iliohypogastric, and Genitofemoral Nerves

Anatomy

Literature Review on the Injection Techniques for Ilioinguinal, Iliohypogastric, and Genitofemoral Nerve Block

Ultrasound-Guided Technique of Ilioinguinal, Iliohypogastric,and Genitofemoral Nerve

Ilioinguinal and Iliohypogastric Nerves

Genital Branch of Genitofemoral Nerve

Piriformis Syndrome

Anatomy

Literature Review on Piriformis Muscle Injections

Ultrasound-Guided Technique for Piriformis Muscle Injection

Pudendal Neuralgia

Anatomy

Literature Review on the Pudendal Nerve Injections

Ultrasound-Guided Technique for Pudendal Nerve Injection

Conclusion

References

17: Ultrasound-Guided Nerve Blocks of the Upper Extremity

Introduction

Brachial Plexus Anatomy

Interscalene Block

Anatomy

Indication

Procedure

Supraclavicular Block

Anatomy

Indication

Procedure

Infraclavicular Block

Anatomy

Indication

Procedure

Axillary Block

Anatomy

Indication

Procedure

Distal Peripheral Nerves in the Upper Extremity

Summary

References

18: Ultrasound-Guided Nerve Blocks of the Lower Limb

General Considerations

Femoral Nerve Block

Clinical Application

Anatomy (Figures .18.3 and .18.4)

Preparation and Positioning

Ultrasound Technique

Single-Injection Technique

Continuous Catheter Technique

Sciatic Nerve Block

Clinical Application

Anatomy

Preparation and Positioning

Ultrasound Technique

Sciatic Nerve Blockade in the Popliteal Fossa

Clinical Application

Anatomy

Preparation and Positioning

Ultrasound Technique

Lumbar Plexus Block

Clinical Application

Anatomy

Preparation and Positioning

Ultrasound Technique

Obturator Nerve Block

Clinical Application

Anatomy

Preparation and Positioning

Ultrasound Technique

Lateral Femoral Cutaneous Nerve Block

Clinical Application

Anatomy

Preparation and Positioning

Ultrasound Technique

Saphenous Nerve Block

Clinical Application

Anatomy

Preparation and Positioning

Ultrasound Technique

Ankle Block

Clinical Application

Anatomy

Preparation and Positioning

Ultrasound Technique

Posterior Tibial Nerve Block

Deep Peroneal Nerve Block

References

19: Ultrasound-Guided Continuous Peripheral Nerve Blocks

Introduction

Applications

Overview of Ultrasound-Guided Perineural Catheter Insertion

Nerve in Short Axis, Needle In-Plane Approach (Figure 19.1)

Nerve in Short Axis, Needle Out-of-Plane (Figure 19.2)

Nerve in Long Axis, Needle In-Plane

Preparation for Ultrasound-Guided Perineural Catheter Insertion

Sterile Technique

Standard Perineural Catheter Equipment

Ultrasound-Guided Perineural Catheter Insertion Techniques for Common Surgical Procedures

Interscalene CPNB

Infraclavicular CPNB

Femoral CPNB

Subgluteal Sciatic CPNB

Popliteal Sciatic CPNB

Tranversus Abdominis Plane CPNB

Conclusion

References

20: Ultrasound-Guided Cervical Sympathetic Block

Introduction

Anatomy

Existing Techniques

Technique for Ultrasound-Guided Injection

References

21: Ultrasound-Guided Peripheral Nerve Blockade in Chronic Pain Management

Introduction

Lateral Femoral Cutaneous Nerve Block

Anatomy

Literature Review of Injection Techniques

Ultrasound-Guided Block Technique

Suprascapular Nerve Block

Anatomy

Literature Review of Injection Techniques

Ultrasound-Guided Block Technique

Intercostal Nerve Block

Anatomy

Literature Review of Injection Techniques

Ultrasound-Guided Block Technique

Conclusion

References

22: Ultrasound-Guided Shoulder Joint and Bursa Injections

Introduction

Subacromial/Subdeltoid Bursa

Anatomy

Clinical Presentation

Limitations of the Blind Approach

Ultrasound-Guided Technique

Biceps Tendon Sheath (Biceps – Long Head)

Anatomy

Clinical Presentation

Ultrasound-Guided Technique

Acromio-Clavicular Joint

Anatomy

Clinical Presentation

Ultrasound-Guided Technique

Glenohumeral Joint

Anatomy

Clinical Presentation

Limitations of the Blind Approach

Ultrasound-Guided Technique

The Rotator Interval Approach

Subscapularis Tendon/Subscapularis Bursa

Anatomy

Clinical Presentation

Ultrasound-Guided Technique

Sternoclavicular Joint

Anatomy

Clinical Presentation

Ultrasound-Guided Technique

Conclusion

References

23: Ultrasound-Guided Hand, Wrist, and Elbow Injections

Introduction

Ultrasound-Guided Carpal Tunnel Injections

Anatomy

Literature Review on Ultrasound-Guided Carpal Tunnel Injections

Ultrasound-Guided Technique for Carpal Tunnel Injection

Ultrasound-Guided Trigger Finger Injections

Anatomy

Literature Review on Ultrasound-Guided Trigger Finger Injections

Ultrasound-Guided Trigger Finger Injection Technique

Ultrasound-Guided Wrist Injections

Anatomy

Literature Review on Ultrasound-Guided Wrist Injections

Ultrasound-Guided Technique for Wrist Injections

Ultrasound-Guided Injections for Tendon Dysfunction

Anatomy

de Quervain’s Tenosynovitis

Intersection Syndrome

Lateral Epicondylitis

Tendon Impingement

Ultrasound-Guided Technique for Tendon Dysfunction

Ultrasound-Guided Elbow Injections

Anatomy

Literature Review on Ultrasound-Guided Elbow Injections

Ultrasound-Guided Elbow Injection Technique

References

24: Ultrasound-Guided Hip Injections

Introduction

Anatomy of the Hip Joint

Intra-Articular Hip Injections

Limitations of the Blind Technique

Evidence for Ultrasound-Guided Hip Injections

Technique of Ultrasound-Guided Hip Injections

Conclusion

References

25: Ultrasound-Guided Knee Injections

Introduction

Limitations of the Current Surface Landmarks Technique

Technique for Ultrasound-Guided Knee Joint Injection

Conclusion

References

26: Ultrasound-Guided Peripheral Nerve Stimulation

Introduction

Current Evidence

Patient Selection and Role of Neurolysis

Anatomical Considerations

Radial Nerve Stimulation

Ulnar Nerve

Median Nerve

Sciatic Nerve at Popliteal Bifurcation

Posterior Tibial Nerve

Conclusion

References

27: Ultrasound-Guided Occipital Stimulation

Introduction

Limitations of the Current ONS Technique

Anatomy of the GON

Occipital Field Stimulation vs. Peripheral Nerve Stimulation

Technique of US-Guided ONS Lead Implant

References

28: Ultrasound-Guided Groin Stimulation

Introduction

Limitations of the Current Technique

Anatomy of the Ilioinguinal and Iliohypogastric Nerves

Groin Field Stimulation vs. Peripheral Nerve Stimulation

Technique of Ultrasound-Guided IL/IH PNS Lead Implant

Reference

29: Ultrasound-Guided Atlanto-Axial and Atlanto-Occipital Joint Injections

Introduction

Anatomy of the Atlanto-Axial and Atlanto-Occipital Joints

Ultrasound-Guided Atlanto-Axial and Atlanto-Occipital Joint Injection Technique

References

30: Ultrasound-Assisted Cervical Diskography and Intradiskal Procedures

Introduction

Limitations of the Fluoroscopically Guided Cervical Diskography

Technique of Ultrasound-Assisted Cervical Diskography

References

Index