The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Ultrasound-Guided Pain Interventions - A Review of Techniques for Peripheral Nerves

  • Soneji, Neilesh (Toronto Western Hospital, University Health Network, University of Toronto) ;
  • Peng, Philip Wenn Hsin (Toronto Western Hospital, University Health Network, University of Toronto)
  • Received : 2013.03.04
  • Accepted : 2013.03.11
  • Published : 2013.04.01
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Abstract

Ultrasound has emerged to become a commonly used modality in the performance of chronic pain interventions. It allows direct visualization of tissue structure while allowing real time guidance of needle placement and medication administration. Ultrasound is a relatively affordable imaging tool and does not subject the practitioner or patient to radiation exposure. This review focuses on the anatomy and sonoanatomy of peripheral non-axial structures commonly involved in chronic pain conditions including the stellate ganglion, suprascapular, ilioinguinal, iliohypogastric, genitofemoral and lateral femoral cutaneous nerves. Additionally, the review discusses ultrasound guided intervention techniques applicable to these structures.

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References

  1. Manchikanti L, Boswell MV, Singh V, Benyamin RM, Fellows B, Abdi S, et al. Comprehensive evidence-based guidelines for interventional techniques in the management of chronic spinal pain. Pain Physician 2009; 12: 699-802.
  2. Davros WJ. Fluoroscopy: basic science, optimal use, and patient/operator protection. Tech Reg Anesth Pain Med 2007; 11: 44-54. https://doi.org/10.1053/j.trap.2007.02.005
  3. Suk JI, Walker FO, Cartwright MS. Ultrasonography of peripheral nerves. Curr Neurol Neurosci Rep 2013; 13:328 https://doi.org/10.1007/s11910-012-0328-x
  4. Bouffard JA, Lee SM, Dhanju J. Ultrasonography of the shoulder. Semin Ultrasound CT MR 2000; 21: 164-191. https://doi.org/10.1016/S0887-2171(00)90041-6
  5. Martinoli C, Bianchi S, Gandolfo N, Valle M, Simonetti S, Derchi LE. US of nerve entrapments in osteofibrous tunnels of the upper and lower limbs. Radiographics 2000; 20 Spec No: S199-S213. https://doi.org/10.1148/radiographics.20.suppl_1.g00oc08s199
  6. Bianchi S, Martinoli C, Bianchi-Zamorani M, Valle M. Ultrasound of the joints. Eur Radiol 2002; 12: 56-61. https://doi.org/10.1007/s00330-001-1162-8
  7. Barrington MJ, Wong DM, Slater B, Ivanusic JJ, Ovens M. Ultrasound-guided regional anesthesia: how much practice do novices require before achieving competency in ultrasound needle visualization using a cadaver model. Reg Anesth Pain Med 2012; 37: 334-339. https://doi.org/10.1097/AAP.0b013e3182475fba
  8. Aeschbach A, Mekhail NA. Common nerve blocks in chronic pain management. Anesthesiol Clin North America 2000; 18: 429-459. https://doi.org/10.1016/S0889-8537(05)70171-1
  9. Lipov EG, Joshi JR, Sanders S, Wilcox K, Lipov S, Xie H, et al. Effects of stellate-ganglion block on hot flushes and night awakenings in survivors of breast cancer: a pilot study. Lancet Oncol 2008; 9: 523-532. https://doi.org/10.1016/S1470-2045(08)70131-1
  10. Mulvaney SW, McLean B, de Leeuw J. The use of stellate ganglion block in the treatment of panic/anxiety symptoms with combat-related post-traumatic stress disorder; preliminary results of long-term follow-up: a case series. Pain Pract 2010; 10: 359-365. https://doi.org/10.1111/j.1533-2500.2010.00373.x
  11. Elias M. Cervical sympathetic and stellate ganglion blocks. Pain Physician 2000; 3: 294-304.
  12. Kakazu CZ, Julka I. Stellate ganglion blockade for acute postoperative upper extremity pain. Anesthesiology 2005; 102: 1288-1289. https://doi.org/10.1097/00000542-200506000-00039
  13. Bhatia A, Flamer D, Peng PW. Evaluation of sonoanatomy relevant to performing stellate ganglion blocks using anterior and lateral simulated approaches: an observational study. Can J Anaesth 2012; 59: 1040-1047. https://doi.org/10.1007/s12630-012-9779-4
  14. Matula C, Trattnig S, Tschabitscher M, Day JD, Koos WT. The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol 1997; 48: 125-131. https://doi.org/10.1016/S0090-3019(96)00441-7
  15. Siegenthaler A, Mlekusch S, Schliessbach J, Curatolo M, Eichenberger U. Ultrasound imaging to estimate risk of esophageal and vascular puncture after conventional stellate ganglion block. Reg Anesth Pain Med 2012; 37: 224-227. https://doi.org/10.1097/AAP.0b013e31823d40fe
  16. Smith KJ, Ladak S, Choi PT, Dobranowski J. The cricoid cartilage and the esophagus are not aligned in close to half of adult patients. Can J Anaesth 2002; 49: 503-507. https://doi.org/10.1007/BF03017931
  17. Smith KJ, Dobranowski J, Yip G, Dauphin A, Choi PT. Cricoid pressure displaces the esophagus: an observational study using magnetic resonance imaging. Anesthesiology 2003; 99: 60-64. https://doi.org/10.1097/00000542-200307000-00013
  18. Narouze S, Vydyanathan A, Patel N. Ultrasound-guided stellate ganglion block successfully prevented esophageal puncture. Pain Physician 2007; 10: 747-752.
  19. Kapral S, Krafft P, Gosch M, Fleischmann D, Weinstabl C. Ultrasound imaging for stellate ganglion block: direct visualization of puncture site and local anesthetic spread. A pilot study. Reg Anesth 1995; 20: 323-328.
  20. Shibata Y, Fujiwara Y, Komatsu T. A new approach of ultrasound-guided stellate ganglion block. Anesth Analg 2007; 105: 550-551. https://doi.org/10.1213/01.ane.0000265691.02963.a4
  21. Christie JM, Martinez CR. Computerized axial tomography to define the distribution of solution after stellate ganglion nerve block. J Clin Anesth 1995; 7: 306-311. https://doi.org/10.1016/0952-8180(95)00037-I
  22. Janik JE, Hoeft MA, Ajar AH, Alsofrom GF, Borrello MT, Rathmell JP. Variable osteology of the sixth cervical vertebra in relation to stellate ganglion block. Reg Anesth Pain Med 2008; 33: 102-108.
  23. Narouze S. Beware of the "serpentine" inferior thyroid artery while performing stellate ganglion block. Anesth Analg 2009; 109: 289-290. https://doi.org/10.1213/ane.0b013e3181a20197
  24. Peng PW, Narouze S. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures: part I: nonaxial structures. Reg Anesth Pain Med 2009; 34: 458-474. https://doi.org/10.1097/AAP.0b013e3181aea16f
  25. Wertheim HM, Rovenstine EA. Suprascapular nerve block. Anesthesiology 1941; 2: 541-545. https://doi.org/10.1097/00000542-194109000-00006
  26. Emery P, Bowman S, Wedderburn L, Grahame R. Suprascapular nerve block for chronic shoulder pain in rheumatoid arthritis. BMJ 1989; 299: 1079-1080. https://doi.org/10.1136/bmj.299.6707.1079
  27. Jones DS, Chattopadhyay C. Suprascapular nerve block for the treatment of frozen shoulder in primary care: a randomized trial. Br J Gen Pract 1999; 49: 39-41.
  28. Karatas GK, Meray J. Suprascapular nerve block for pain relief in adhesive capsulitis: comparison of 2 different techniques. Arch Phys Med Rehabil 2002; 83: 593-597. https://doi.org/10.1053/apmr.2002.32472
  29. Shanahan EM, Ahern M, Smith M, Wetherall M, Bresnihan B, FitzGerald O. Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain. Ann Rheum Dis 2003; 62: 400-406. https://doi.org/10.1136/ard.62.5.400
  30. Gleeson AP, Graham CA, Jones I, Beggs I, Nutton RW. Comparison of intra-articular lignocaine and a suprascapular nerve block for acute anterior shoulder dislocation. Injury 1997; 28: 141-142. https://doi.org/10.1016/S0020-1383(96)00167-2
  31. Ritchie ED, Tong D, Chung F, Norris AM, Miniaci A, Vairavanathan SD. Suprascapular nerve block for postoperative pain relief in arthroscopic shoulder surgery: a new modality? Anesth Analg 1997; 84: 1306-1312. https://doi.org/10.1213/00000539-199706000-00024
  32. Neal JM, McDonald SB, Larkin KL, Polissar NL. Suprascapular nerve block prolongs analgesia after nonarthroscopic shoulder surgery but does not improve outcome. Anesth Analg 2003; 96: 982-986.
  33. Romeo AA, Rotenberg DD, Bach BR Jr. Suprascapular neuropathy. J Am Acad Orthop Surg 1999; 7: 358-367. https://doi.org/10.5435/00124635-199911000-00002
  34. Natsis K, Totlis T, Tsikaras P, Appell HJ, Skandalakis P, Koebke J. Proposal for classification of the suprascapular notch: a study on 423 dried scapulas. Clin Anat 2007; 20: 135-139. https://doi.org/10.1002/ca.20318
  35. Peng PW, Wiley MJ, Liang J, Bellingham GA. Ultrasoundguided suprascapular nerve block: a correlation with fluoroscopic and cadaveric findings. Can J Anaesth 2010; 57: 143-148. https://doi.org/10.1007/s12630-009-9234-3
  36. Feigl GC, Anderhuber F, Dorn C, Pipam W, Rosmarin W, Likar R. Modified lateral block of the suprascapular nerve: a safe approach and how much to inject? A morphological study. Reg Anesth Pain Med 2007; 32: 488-494.
  37. Mallon WJ, Brown HR, Vogler JB 3rd, Martinez S. Radiographic and geometric anatomy of the scapula. Clin Orthop Relat Res 1992; (277): 142-154.
  38. Shah RV, Racz GB. Pulsed mode radiofrequency lesioning of the suprascapular nerve for the treatment of chronic shoulder pain. Pain Physician 2003; 6: 503-506.
  39. Schneider-Kolsky ME, Pike J, Connell DA. CT-guided suprascapular nerve blocks: a pilot study. Skeletal Radiol 2004; 33: 277-282. https://doi.org/10.1007/s00256-003-0733-y
  40. Moore DC. Block of the suprascapular nerve. In: Regional nerve block. 4th ed. Edited by Thomas CC, Springfield, IL, Charles C Thomas Publisher LTD. 1979, pp 300-303.
  41. Gofeld M. Ultrasonography in pain medicine: a critical review. Pain Pract 2008; 8: 226-240. https://doi.org/10.1111/j.1533-2500.2008.00215.x
  42. Harmon D, Hearty C. Ultrasound-guided suprascapular nerve block technique. Pain Physician 2007; 10: 743-746.
  43. Yucesoy C, Akkaya T, Ozel O, Comert A, Tuccar E, Bedirli N, et al. Ultrasonographic evaluation and morphometric measurements of the suprascapular notch. Surg Radiol Anat 2009; 31: 409-414. https://doi.org/10.1007/s00276-008-0458-7
  44. Siegenthaler A, Moriggl B, Mlekusch S, Schliessbach J, Haug M, Curatolo M, et al. Ultrasound-guided suprascapular nerve block, description of a novel supraclavicular approach. Reg Anesth Pain Med 2012; 37: 325-328. https://doi.org/10.1097/AAP.0b013e3182409168
  45. Rab M, Ebmer J, Dellon AL. Anatomic variability of the ilioinguinal and genitofemoral nerve: implications for the treatment of groin pain. Plast Reconstr Surg 2001; 108: 1618-1623. https://doi.org/10.1097/00006534-200111000-00029
  46. Alfieri S, Rotondi F, Di Giorgio A, Fumagalli U, Salzano A, Di Miceli D, et al. Influence of preservation versus division of ilioinguinal, iliohypogastric, and genital nerves during open mesh herniorrhaphy: prospective multicentric study of chronic pain. Ann Surg 2006; 243: 553-558. https://doi.org/10.1097/01.sla.0000208435.40970.00
  47. Whiteside JL, Barber MD, Walters MD, Falcone T. Anatomy of ilioinguinal and iliohypogastric nerves in relation to trocar placement and low transverse incisions. Am J Obstet Gynecol 2003; 189: 1574-1578. https://doi.org/10.1016/S0002-9378(03)00934-7
  48. Seid AS, Amos E. Entrapment neuropathy in laparoscopic herniorrhaphy. Surg Endosc 1994; 8: 1050-1053. https://doi.org/10.1007/BF00705717
  49. Brandsborg B, Nikolajsen L, Kehlet H, Jensen TS. Chronic pain after hysterectomy. Acta Anaesthesiol Scand 2008; 52: 327-331. https://doi.org/10.1111/j.1399-6576.2007.01552.x
  50. Aasvang E, Kehlet H. Chronic postoperative pain: the case of inguinal herniorrhaphy. Br J Anaesth 2005; 95: 69-76. https://doi.org/10.1093/bja/aei019
  51. Mandelkow H, Loeweneck H. The iliohypogastric and ilioinguinal nerves. Distribution in the abdominal wall, danger areas in surgical incisions in the inguinal and pubic regions and reflected visceral pain in their dermatomes. Surg Radiol Anat 1988; 10: 145-149. https://doi.org/10.1007/BF02307823
  52. al-dabbagh AK. Anatomical variations of the inguinal nerves and risks of injury in 110 hernia repairs. Surg Radiol Anat 2002; 24: 102-107. https://doi.org/10.1007/s00276-002-0006-9
  53. Liu WC, Chen TH, Shyu JF, Chen CH, Shih C, Wang JJ, et al. Applied anatomy of the genital branch of the genitofemoral nerve in open inguinal herniorrhaphy. Eur J Surg 2002; 168: 145-149. https://doi.org/10.1080/110241502320127748
  54. Katz J. Atlas of regional anesthesia. Norwalk, CT, Appleton- Century-Crofts. 1985.
  55. Brown D. Atlas of regional anesthesia. Philadelphia, PA, WB Saunders. 1999.
  56. van Schoor AN, Boon JM, Bosenberg AT, Abrahams PH, Meiring JH. Anatomical considerations of the pediatric ilioinguinal/iliohypogastric nerve block. Paediatr Anaesth 2005; 15: 371-377. https://doi.org/10.1111/j.1460-9592.2005.01464.x
  57. Weintraud M, Marhofer P, Bosenberg A, Kapral S, Willschke H, Felfernig M, et al. Ilioinguinal/iliohypogastric blocks in children: where do we administer the local anesthetic without direct visualization? Anesth Analg 2008; 106: 89-93. https://doi.org/10.1213/01.ane.0000287679.48530.5f
  58. Ghani KR, McMillan R, Paterson-Brown S. Transient femoral nerve palsy following ilio-inguinal nerve blockade for day case inguinal hernia repair. J R Coll Surg Edinb 2002; 47: 626-629.
  59. Johr M, Sossai R. Colonic puncture during ilioinguinal nerve block in a child. Anesth Analg 1999; 88: 1051-1052. https://doi.org/10.1213/00000539-199905000-00015
  60. Amory C, Mariscal A, Guyot E, Chauvet P, Leon A, Poli-Merol ML. Is ilioinguinal/iliohypogastric nerve block always totally safe in children? Paediatr Anaesth 2003; 13: 164-166. https://doi.org/10.1046/j.1460-9592.2003.01005.x
  61. Vaisman J. Pelvic hematoma after an ilioinguinal nerve block for orchialgia. Anesth Analg 2001; 92: 1048-9.
  62. Waldman SD. Atlas of interventional pain management. 2nd ed. Philadelphia, PA, Saunders. 2004.
  63. Eichenberger U, Greher M, Kirchmair L, Curatolo M, Moriggl B. Ultrasound-guided blocks of the ilioinguinal and iliohypogastric nerve: accuracy of a selective new technique confirmed by anatomical dissection. Br J Anaesth 2006; 97: 238-243. https://doi.org/10.1093/bja/ael103
  64. Hu P, Harmon D, Frizelle H. Ultrasound guidance for ilioinguinal/iliohypogastric nerve block: a pilot study. Ir J Med Sci 2007; 176: 111-115. https://doi.org/10.1007/s11845-007-0017-y
  65. Gofeld M, Christakis M. Sonographically guided ilioinguinal nerve block. J Ultrasound Med 2006; 25: 1571-1575. https://doi.org/10.7863/jum.2006.25.12.1571
  66. Gucev G, Yasui GM, Chang TY, Lee J. Bilateral ultrasound-guided continuous ilioinguinal-iliohypogastric block for pain relief after cesarean delivery. Anesth Analg 2008; 106: 1220-1222. https://doi.org/10.1213/ane.0b013e3181683821
  67. Jamieson RW, Swigart LL, Anson BJ. Points of parietal perforation of the ilioinguinal and iliohypogastric nerves in relation to optimal sites for local anaesthesia. Q Bull Northwest Univ Med Sch 1952; 26: 22-26.
  68. Peng PW, Tumber PS. Ultrasound-guided interventional procedures for patients with chronic pelvic pain - a description of techniques and review of literature. Pain Physician 2008; 11: 215-224.
  69. Grossman MG, Ducey SA, Nadler SS, Levy AS. Meralgia paresthetica: diagnosis and treatment. J Am Acad Orthop Surg 2001; 9: 336-344. https://doi.org/10.5435/00124635-200109000-00007
  70. Harney D, Patijn J. Meralgia paresthetica: diagnosis and management strategies. Pain Med 2007; 8: 669-677. https://doi.org/10.1111/j.1526-4637.2006.00227.x
  71. Shannon J, Lang SA, Yip RW, Gerard M. Lateral femoral cutaneous nerve block revisited. A nerve stimulator technique. Reg Anesth 1995; 20: 100-104.
  72. Dias Filho LC, Valenca MM, Guimaraes Filho FA, Medeiros RC, Silva RA, Morais MG, et al. Lateral femoral cutaneous neuralgia: an anatomical insight. Clin Anat 2003; 16: 309-316. https://doi.org/10.1002/ca.10106
  73. de Ridder VA, de Lange S, Popta JV. Anatomical variations of the lateral femoral cutaneous nerve and the consequences for surgery. J Orthop Trauma 1999; 13: 207-211. https://doi.org/10.1097/00005131-199903000-00009
  74. Ropars M, Morandi X, Huten D, Thomazeau H, Berton E, Darnault P. Anatomical study of the lateral femoral cutaneous nerve with special reference to minimally invasive anterior approach for total hip replacement. Surg Radiol Anat 2009; 31: 199-204. https://doi.org/10.1007/s00276-008-0433-3
  75. Grothaus MC, Holt M, Mekhail AO, Ebraheim NA, Yeasting RA. Lateral femoral cutaneous nerve: an anatomic study. Clin Orthop Relat Res 2005; (437): 164-168.
  76. Aszmann OC, Dellon ES, Dellon AL. Anatomical course of the lateral femoral cutaneous nerve and its susceptibility to compression and injury. Plast Reconstr Surg 1997; 100: 600-604. https://doi.org/10.1097/00006534-199709000-00008
  77. Murata Y, Takahashi K, Yamagata M, Shimada Y, Moriya H. The anatomy of the lateral femoral cutaneous nerve, with special reference to the harvesting of iliac bone graft. J Bone Joint Surg Am 2000; 82: 746-747. https://doi.org/10.2106/00004623-200005000-00016
  78. Patel NJ, Flashburg MH, Paskin S, Grossman R. A regional anesthetic technique compared to general anesthesia for outpatient knee arthroscopy. Anesth Analg 1986; 65: 185-187. https://doi.org/10.1097/00000542-198609001-00184
  79. Hopkins PM, Ellis FR, Halsall PJ. Evaluation of local anaesthetic blockade of the lateral femoral cutaneous nerve. Anaesthesia 1991; 46: 95-96. https://doi.org/10.1111/j.1365-2044.1991.tb09347.x
  80. Ng I, Vaghadia H, Choi PT, Helmy N. Ultrasound imaging accurately identifies the lateral femoral cutaneous nerve. Anesth Analg 2008; 107: 1070-1074. https://doi.org/10.1213/ane.0b013e31817ef1e5
  81. Bodner G, Bernathova M, Galiano K, Putz D, Martinoli C, Felfernig M. Ultrasound of the lateral femoral cutaneous nerve: normal findings in a cadaver and in volunteers. Reg Anesth Pain Med 2009; 34: 265-268. https://doi.org/10.1097/AAP.0b013e31819a4fc6
  82. Hurdle MF, Weingarten TN, Crisostomo RA, Psimos C, Smith J. Ultrasound-guided blockade of the lateral femoral cutaneous nerve: technical description and review of 10 cases. Arch Phys Med Rehabil 2007; 88: 1362-1364. https://doi.org/10.1016/j.apmr.2007.07.013
  83. Tumber PS, Bhatia A, Chan VW. Ultrasound-guided lateral femoral cutaneous nerve block for meralgia paresthetica. Anesth Analg 2008; 106: 1021-1022.
  84. Damarey B, Demondion X, Boutry N, Kim HJ, Wavreille G, Cotten A. Sonographic assessment of the lateral femoral cutaneous nerve. J Clin Ultrasound 2009; 37: 89-95. https://doi.org/10.1002/jcu.20521

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