Download eZono distributor training Regional Anesthesia Guide

eZono distributor training
Regional Anesthesia Guide
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eZono distributor Training
Regional Anesthesia Guide
Overview of regional anesthesia Blocks shown in this brochure:
Plexus Brachialis
Interscalene Pl. Br.
1
Supraclavicular Pl. Br.
2
Infraclavicular Pl. Br.
3
Axillary Block
4
Trunk
N. Intercostalis
5
TAP Block (transversus abdominis plane)
6
Epidural & Spinal
7-8
Leg ventral
N. Femoralis
9
Saphenous Nerve Block
10
Lateral Femoral Cutaneous Nerve Block
11
Obturatorius Nerve
12
Leg dorsal
Proximal N. Ischiadicus
13
Medial Femoral sciatic Nerve Block
14
Distal N. Ischiadicus
15
Plexus Brachialis
ezono
Interscalene Pl. Br.
Supine position, contralateral head rotation 15 °- 30 °.
Place the probe at the level
of the cricoid cartilage one
finger‘s breadth above the
clavicle (ventral neck). Slide
the probe laterally from the
thyroid gland towards the
scalenic muscles. Tilt your
probe carfully To receive the
best view of Pl. Br..
M. STERNOCLEIDOMASTOIDEUS
M. SCALENUS ANTERIOR
M. SCALENUS MEDIUS
PLEXUS BRACHIALIS
ventro-lateral
M. LONGUS COLLI
dorsal
1
ezono
Supraclavicular Pl. Br.
Supine position, contralateral
head rotation 15 °- 30 °.
Place the probe cranially, parallel to the medial part of the
clavicle, and facing slightly in
the direction of the chest. Slide
the probe above and behind the
clavicle, aiming towards the
first rib or pleura.
PL. BRACHIALIS
M. SCALENUS
ANTERIOR
A. SUBCLAVIA
M. SCALENUS
MEDIUS
RIB/COSTA
ventrocranial
PLEURA
dorsal
2
Infraclavicular Pl. Br. ( central approach)
Scan the infraclavicular region from below the central
clavicula to the lateral edge
of the pectoralis major muscle. The three infraclavicular regions, medial, central
and lateral are distinguished
by the pectoralis muscle.
ventral
caudal
3
ezono
ezono
Axillary Block
The supine position, arm abducted to 90° and externally
rotated. Place the probe
transversely to the lateral
region of the axilla. and the
triceps muscles. Tilt or slide
the probe along the upper
arm and the axilla. Scan the
nreves Course for 3-4 cm.
The Nerves branches are
located around the artery.
V. BRACHIALIS
M. BICEPS BRACHII
A. BRACHIALIS
M. TERES MAJOR
HUMERUS
medial
dorsal
4
Trunk
ezono
N. Intercostalis
Supine, prone, sitting or
leaning forward (for example, sitting backwards
on a chair with arms resting on its back). Place the
probe perpendicular to the
ribs, between the pain area
and the spinal cord. Slide
the probe transversely to
the axis of the ribs.
M. INTERCOSTALIS
EXTERNUS
RIB
superficial
inferior
5
LIS
OSTA
TERC
M. IN ERNUS
INT
INJECTION AREA
PLEURA
RIB
TAP Block (transversus abdominis plane)
ezono
The patient is in the supine
position. Place the probe
ipsilateral at the edge of
rectus at the beginning of
the 3 muscles, External and
Internal Obliqus and Transversus Abdominis. Slide probe from the medial to lateral
abdominal wall behind the
midaxillary line. Place between iliac crest and most
inferior rib.
EXTERNAL OBLIQUE ABD.
INTERNAL OBLIQUE ABD.
TAP-TRANSVERSUS ABD. PLANE
TRANSVERSUS ABD.
PERITONEUM
lateral
dorsal
6
ezono
Epidural and Spinal Block
1. Find the mid-line
Scan in the transverse direction. The
bones shadows typically form an angel
shape. Identify the spinal process.
dorsal
lateral
7
lateral
ezono
2. Paramedian Approach
Rotate probe 90 degrees from transversal to longitudinal view and image
roughly 2cm from mid-line. Look for
the repeating pattern of the vertebrae.
Identify the facet joints.
We target the fourth and third intervertebral space. Scan upwards from
the sacrum. Identify the the space
between the 3rd and 4th vertebrae and
mark your spot for injection.
3. Target anatomy
Epidural space landmarks: facet joints,
ligamentum flavum and dura mater.
Spinal space landmarks: facet joints,
ligamentum flavum and dura mater.
4. Injection
For accurate puncture, measure distance from skin to dura mater/ ligamentum flavum as indicated. After
measurement, insert needle at marked
point and follow loss of resistance
technique using measured distance as
a guide.
8
Leg ventral
ezono
N. Femoralis
Supine position, leg to be
blocked is slightly abducted
and externally rotated. Place
the probe on the medial groin. Slide the probe along the
medial part of the groin.
FEMORAL N.
FEMORAL ARTERY
M. ILIOPSOAS
ventral
medial
9
M. PECTINEUS
Saphenous Nerve Block
ezono
Patient in supine position.
Leg is raised over contralateral thigh. Place probe
transversal on midline of leg,
one handwidth above patella. Slide probe medially.
10
Lateral Femoral Cutaneous Nerve Block
Patient in supine position.
Place the probe on the Spina
iliaca ant. Sup. – SIAS. Silde the probe 1-3 cm distally
and rotate the probe on the
medial side to position it parallel to the inguinal ligament
11
ezono
Obturatorius Nerve Block
ezono
Patient in supine position, leg
to be blocked slightly adducted and slightly externally
rotated. Place probe medial
on the inguinal crease. Slide
the probe slightly medial.
Move the probe beneath the
inguinal crease to the front
inner thigh. Notice that there
is a high anatomical Variation
of this nerve. Only injection in
both divisions will complete
the block.
12
Leg dorsal
ezono
Proximal N. Ischiadicus / subgluteal
Sub-/trans-gluteal Approach: Prone position. Place
the probe over the sub-/
trans-gluteal region with the
probe perpendicular to the
leg axis. Optimize the angle
of the probe (anisotropy).
SCIATIC NERVE
TUBER
ISCHIADIKUM
dorsal
lateral
13
UR
F
EM
Medial Femoral sciatic Nerve Block
ezono
Prone position. Knee is
slightly flexed. Place the
probe at the popliteal. Scan
from the Fossa poplitea, nerve lies dorsal to the vessels,
to the mid/superior thigh,
nerve lies between the muscles. Beware the anisotropy.
14
ezono
Distal N. Ischiadicus / popliteal approach
Prone position with slightly
bent knee. Place the probe
on the popliteal fossa with
the probe perpendicular to
the leg axis. Slide the probe
cranially along the upper
part of the popliteal fossa
and adjust the probe position to optimize visualization
(anisotropy).
M. SEMITENDINEUS
M.BICEPS FEMORIS
M. SEMIMEMBRANOSUS
M. SEMITENDINEUS
dorsal
lateral
15
Informacje dodatkowe
Kontakt
MS MEDICAL
ul. Bolesława Chrobrego 18
41-500 Chorzów
Mail
[email protected]
WWW
www.msmedical.pl
Telefon
+ 48 660 902 127
+ 48 690 516 027
+48 698 652 913