Due to huge demand in 2016, the Ultrasound workshops in Euroanaesthesia 2017 were expanded to cover all three days of the congress.
With the advent of ultrasound guidance there is renewed and increasing interest in regional anaesthesia, explained by alleged improved success rates and fewer complications. However, a lot remains to be done in terms of acquisition of a new skill set by both existing specialists and novices in anaesthesia.
One set of Ultrasound Workshops were chaired by Dr Eric Albrecht, Attending Anaesthesiologist at the Lausanne University Hospital in Switzerland and Programme Director of Regional Anaesthesia. He is the main author of a French book on ultrasound-guided regional anaesthesia published by Elsevier-Masson. His field of research includes meta-analyses and prospective trials on acute postoperative pain, regional procedures, and complications after peripheral nerve blocks.
“These workshops are ideal for colleagues whose training took place before ultrasound was widely used, or those who are simply looking to improve their skills,” explains Dr Albrecht. “The six different stations we had helped delegates to recognise the internal structures, identify the nerves, and position the needle tip for ideal regional anaesthesia.”
Among the team demonstrating the blocks at this year’s workshops were:
Dr Andreas Bűrgi, Hirslanden Clinic, Zurich, Switzerland:
“In this hands-on session we talked about the indications and different approaches to infraclavicular and axillary plexus blocks,” he explained.
He said: “For infraclavicular blocks, the participants learned to identify the brachial plexus at the level of the cords (posterior, lateral and medial) and their relationship to the axillary vessels. We discussed the medial and lateral approaches and their advantages in terms of catheter placement and safety. As it is a comparably deep block with target structures, it is a procedure where needle visualisation is a chapter of its own”
He added: “For axillary blocks, as the cords of the brachial plexus move distally into the axilla, they split up into their terminal branches. We talked about where we can find them and how to safely identify radial, medial, ulnar and musculocutaneous nerves. Also, the participants learned when, where and how to do rescue blocks.”
Dr Moira Baeriswyl, Centre Hospitalier Universitaire Vaudois, Lausanne, Swtizerland:
Dr Baeriswyl demonstrated chest and abdominal wall blocks. She said: “Participants were taught how to systematically scan the chest wall and abdominal wall. This enabled them to recognise the structures necessary to perform a pectoral block (PEC 1 and PEC 2) as well as a serratus plane block; to recognise the structures necessary to perform a transversus abdominis plane block. Participants were taught to interpret the ultrasound images of these blocks and the analgesic areas they cover.”
Dr Andrea Saporito Bellinzona Regional Hospital, Bellinzona, Switzerland:
Dr Saporito dealt with sciatic nerve blocks in his presentation. He said: “Providing sensitive and motor innervation to all the joints, the major muscular groups and vast portions of the skin of the lower limb, sciatic nerve is a major target for regional anaesthesia. Ultrasound guidance has revolutionised the classic approaches based on landmarks, which somehow limited the possible needle insertion points, shifting the focus on needle and target visualisation. Possible approaches for sciatic nerve block have thus multiplied, the main concern being to obtain the best visualisation possible of the nerve and the safest needle to nerve track.”
He added: “With regard to nerve visualisation, the sciatic nerve offers unique challenges: proximal to the popliteal fossa it is not in proximity with vascular structures, which are the main ultrasound landmarks and it lies deep underneath big muscles. Moreover, the nerve is S shaped and this poses the problem of compensating for anisotropy, which by deflecting the ultrasound echo, can reduce its echogenicity. This confers particular importance to the ability of the operator in modifying the position of the probe in order to optimising nerve visualisation by having the ultrasound beam as perpendicular as possible with respect to its long axis. Probe tilting, rotation and sliding are fundamental skills we teach in this workshop in order to track the sciatic nerve from the popliteal fossa, where its tibial component is easier to locate, up to the sub-gluteal region.”
He concluded: “With regard to safety, we learned how to avoid major complications by exploiting the advantage ultrasound confers when applied to interventional medicine such as the visualisation of vascular and other sensitive structures we must consider when choosing the optimal needle insertion point.”
Dr Cedric Luyet, Lindenhof Hospital, Bern, Swizterland:
Dr Luyet said: “The participants of the workshop were taught how to scan the thoracic and lumbar vertebral column. The advantage of the preprocedural ultrasound imaging versus the manual palpation for landmark recognition was discussed. Different ultrasound-guided accesses to the paravertebral space was shown and their respective advantages or disadvantages for continuous versus single injection techniques were discussed. Furthermore, different accesses to the lumbar spinal and epidural space were also demonstrated. Training was also provided for the scanning of the cervical spine and lumbar spine with its facet joints and medial branches and the sacroiliac joint.”