‘Hand-carried ultrasound systems help in performing safe nerve and plexus blocks’

When did you start using ultrasound and how long you have been using it?

Dr Surinder M Sharma

I started using ultrasound in year 2004 but not on a regular basis. Since last two and a half years, I have started using it extensively in almost every procedure. Technological advancements in ultrasound systems are providing great benefits in point-of-care delivery.

What do you find most useful about Hand-carried ultrasound (HCU) system in POC?

The easy portability of the HCU systems is the key distinguishing characteristic. Being lightweight, it can be carried directly to the patients, enabling one to perform safe and efficient nerve and plexus blocks with quicker and more informed diagnostic decisions.

Are these hand carried ultrasound systems user friendly?

SonoSite hand-carried ultrasound system is easy to understand. It boots up very quickly and has excellent image quality with good battery backup. These are the desired key features that a healthcare practitioner always seeks in a system. It is rightly said that you only see what you know. Hence, anesthesiologists need to develop a careful understanding of the anatomical structures involved, and acquire proper understanding of ultrasound technology for the practical skills to visualise nerve structures.

How accurate and efficient is HCU in nerve blocks and plexus blocks? What are the benefits of point of care ultrasound?

In the past, there were no other modalities available to see the position of the needle and parasthesias were actively sought. Parasthesia for anaesthesia was the order of the day. But blind blocks that relied solely on anatomical landmarks and/or fascia clicks sometimes used to be traumatic and could lead to serious complications during procedure.

The usage of HCU reduces the block performance time and enables direct visualisation of the distribution of local anaesthetics. The high quality imaging probes improve the efficiency and help to avoid the complications. This has changed the perception to avoid parasthesia to avoid dysaesthesia. At the time when pain is severe and there is urgent need to infuse the anaesthetic fluid , ultrasound guidance enables the anesthesiologist to secure an accurate needle position to monitor the distribution of the local anaesthetic in real time. In addition, the amount of local anaesthetic needed for effective nerve block can be managed by directly monitoring its distribution.

Does it increase the safety profile of nerve block systems?

Yes, it definitely does. Earlier, it was like a blind man even without a stick, but later nerve stimulators improved block outcomes. Now, the introduction of HCU has revolutionised the practice of administering nerve blocks. Needle guidance under direct visualisation helps avoiding vital structures like blood vessels, pleura, peritoneum etc. and injecting local anesthetic more accurately thereby enhancing the safety profile of the nerve block systems. For a successful regional anaesthetic block, anesthesiologists have to make sure the optimal distribution of local anaesthetic around nerve structures. This goal is achieved most effectively under ultrasound visualisation. It can significantly improve the quality of nerve blocks in almost all types of regional anaesthesia. In addition, complications such as intraneuronal injection can be avoided.

How efficient is HCU in putting perineural catheters?

I have been putting perineural catheters for quite some time, but since I have started using ultrasound technique, it has made things easier. Use of point-of-care ultrasound guidance can potentially decrease neuraxial damage while correctly placing a perineural catheter.

Any role of nerve stimulator along with ultrasound?

Initially, if the physicians are not well versed with the basics of ultrasound imaging they may use nerve stimulator to identify specific nerves, as basic understanding of ultrasound theory is vitally important for the safe use of this technology. The physician’s knowledge of anatomy is fundamental to the safe practice of ultrasound-guided regional anesthesia. However, gradually when the physician has enough knowledge of using ultrasound technique, there is a limited role of a nerve stimulator e.g. in deeply placed nerves. As nerve stimulator causes muscle contractions, often patients may not be comfortable. Soon patients may ask for block with a scanner rather than a blind procedure/ nerve stimulator.