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Track the Tiny Strings: Live Scanning of Small Truncal Nerves including Phrenic nerve, Dorsal Scapular Nerve, Suprascapular Nerve, Ilioinguinal & Iliohypogastric Nerve
Abstracts both can have devastating complications that leaves these options to centers with a broad experience and high number of operations. Not even 10% of the anesthesiologist use this approach. The PECS block and serrates plane blocks were described by myself as a simple, quick and effective solution to the pack of postoperative pain management for thoracic procedures of any kind, for chronic pain managements and even for pain management following thoracic trauma. Ultrasound has allows to provide multiple variation of the same thing but is it really something else or we are just trying to put our grain of sand in the mountain. In this lecture new will provide evidence and logical thinking about what is a fascial plane block, the different mechanism by which they can work, not only via macroscopic anatomy and how relevant it is to implement these techniques in our daily basis. Eighty percent of the surgery is perform as ambulatory surgery therefore a simple safe technique has a space as a workable solution to pain management. The Pecs block and serrates plane blocks have revolutionised the way we approach acute pain in the XXI century and it came here to stay. T14-15-IN04 Adventure on VATS Block Jui-An Lin, MD, PhD Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taiwan For selected surgical procedures, the use of peripheral regional anesthetic blocks may avoid general anesthesia and increase efficiency of the surgical pathway. However, evidence on peripheral truncal anesthetic blocks is scarce. Despite non-intubated video-assisted thoracoscopic surgery (VATS) has been reported under local anesthesia in detail with safety, feasibility and favorable results, suboptimal anesthetic status still occurs with moderate pain during surgery. Furthermore, to reduce associated trauma and related chronic pain and paresthesia, a more recent development is the introduction of single (uni) port or incision VATS which has the advantage of involving only one intercostal space for access to thoracic surgery. For uniportal VATS, we would like to investigate the feasibility of ultrasound-guided peripheral truncal anesthetic block combining serratus plane block and intercostal plane block to improve the quality of local anesthesia. Meanwhile, serial plasma ropivacaine concentrations are also measured following VATS block injection to test if the plasma level of ropivacaine reaches its toxic range at this setting. In this presentation the speaker will present the details of VATS block and experience from his ongoing research on this technique. Practical tips for VATS block will also be disclosed.
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T14-15-IN06 Usefulness of Shamrock View for Deep Nerve Blocks Tatsuo Nakamoto Regional Anesthesia and Pain Medicine, Kansai Medical University, Hirakata, Osaka, JAPAN Ultrasound guided nerve blocks have extremely developed in last one decade. However, Deep nerve blocks using ultrasound assist, especially the lumbar paravertebral region, have had disadvantage about the quality of the image and the artifact caused by bony structures compare with superficial nerve blocks. Recently, a novel approach to lumbar paravertebral region, Shamrock view reported by Sauter et.al., has attracted rising attention. There are several advantages in performing lumbar plexus block and quadratic lumbermen block for perioperative pain management, and lumbar root block and transforaminal epidural block for Interventional pain therapy. ‘‘Shamrock’’ was named from the ultrasound image of three muscle, psoas major muscles, quadratus lumborum muscle, and erector spine muscle, around lumbar transverse process as like three-leafs clover. This scan is superior to the standard posterior scan in the point that acoustic shadow of transverse process does NOT interfere the image of psoas major muscle. The needle visibility is also extremely better because of perpendicular reflection to the needle. Furthermore, structures in the lumbar spinal canal, dura and subarachnoid space, were also visible through the intervertebral foramen using Shamrock view. This provides a lot of information when we perform the lumbar paravertebral block and interventional procedures. We will present Tips of these techniques in our clinical practice. T14-15-IN07 Track the Tiny Strings: Live Scanning of Small Truncal Nerves including Phrenic nerve, Dorsal Scapular Nerve, Suprascapular Nerve, Ilioinguinal & Iliohypogastric Nerve Chih-Peng Lin, MD, PhD, FIPP, CIPS Division of Pain Medicine, Department of Anesthesiology, National Taiwan University Hospital Tracking small peripheral nerves by high resolution ultrasound is an essential technique for US-guided pain management to achieve not only symptom relief but also avoid procedure related complications. In this life-scan section, we will be demonstrating nerve tracking technique of phrenic nerve, dorsal scapular nerve (interscapular pain), suprascapular nerve (refractory shoulder pain) and ilioinguinal & iliohypogastric nerve (refractory groin pain).
T14-15-IN05 Free Paper Parasternal Intercostal Nerve Block Yasuyuki Shibata, MD, PhD Associate director of surgical section, Faculty of department of Anesthesiology, Nagoya University Hospital The intercostal nerves reside in the neurovascular space between the parietal pleura and the internal intercostal membrane/muscle. This intercostal neurovascular space is visualized as a thick space on the posterior chest wall and near the sternum. In the intercostal neurovascular space near the sternum, the anterior cutaneous and the collateral branch of the intercostal nerve from T1 to T6 are located and innervate the sternum and the skin around the sternum. Therefore, parasternai intercostal nerve block, a technique of injecting local anesthetic into the intercostal neurovascular space near the sternum is indicated for midline sternotomy and sternal fracture. As for ultrasound guided technique, the internal mammary artery and the transverse thoracic muscle are a good landmark to detect the intercostal neurovascular space near the sternum. Here, I would like to share the technique of parasternal intercostal nerve block.
OPT14-001 Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso. Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose in Water (D5W) as the Primary Hydrodissection King Hei Stanley Lam,1 Kenneth Dean Reeves,2 An Lin Cheng3 1 Department of Family Medicine, Chinese University of Hong Kong, Hong Kong, 2Department of Physical Medicine and Rehabilitation., University of Kansas, Kansas, United States, 3Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, United States Objectives: Although low-level studies demonstrate effectiveness of nerve hydrodissection, there are no high level studies to date.4 Prior to high-level study performance, procedural methods must be described that are reproducibly performed, reliable in effect, and safe. The objectives of this article are to
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T14-15-IN06 Usefulness of Shamrock View for Deep Nerve Blocks Tatsuo Nakamoto Regional Anesthesia and Pain Medicine, Kansai Medical University, Hirakata, Osaka, JAPAN Ultrasound guided nerve blocks have extremely developed in last one decade. However, Deep nerve blocks using ultrasound assist, especially the lumbar paravertebral region, have had disadvantage about the quality of the image and the artifact caused by bony structures compare with superficial nerve blocks. Recently, a novel approach to lumbar paravertebral region, Shamrock view reported by Sauter et.al., has attracted rising attention. There are several advantages in performing lumbar plexus block and quadratic lumbermen block for perioperative pain management, and lumbar root block and transforaminal epidural block for Interventional pain therapy. ‘‘Shamrock’’ was named from the ultrasound image of three muscle, psoas major muscles, quadratus lumborum muscle, and erector spine muscle, around lumbar transverse process as like three-leafs clover. This scan is superior to the standard posterior scan in the point that acoustic shadow of transverse process does NOT interfere the image of psoas major muscle. The needle visibility is also extremely better because of perpendicular reflection to the needle. Furthermore, structures in the lumbar spinal canal, dura and subarachnoid space, were also visible through the intervertebral foramen using Shamrock view. This provides a lot of information when we perform the lumbar paravertebral block and interventional procedures. We will present Tips of these techniques in our clinical practice. T14-15-IN07 Track the Tiny Strings: Live Scanning of Small Truncal Nerves including Phrenic nerve, Dorsal Scapular Nerve, Suprascapular Nerve, Ilioinguinal & Iliohypogastric Nerve Chih-Peng Lin, MD, PhD, FIPP, CIPS Division of Pain Medicine, Department of Anesthesiology, National Taiwan University Hospital Tracking small peripheral nerves by high resolution ultrasound is an essential technique for US-guided pain management to achieve not only symptom relief but also avoid procedure related complications. In this life-scan section, we will be demonstrating nerve tracking technique of phrenic nerve, dorsal scapular nerve (interscapular pain), suprascapular nerve (refractory shoulder pain) and ilioinguinal & iliohypogastric nerve (refractory groin pain).
T14-15-IN05 Free Paper Parasternal Intercostal Nerve Block Yasuyuki Shibata, MD, PhD Associate director of surgical section, Faculty of department of Anesthesiology, Nagoya University Hospital The intercostal nerves reside in the neurovascular space between the parietal pleura and the internal intercostal membrane/muscle. This intercostal neurovascular space is visualized as a thick space on the posterior chest wall and near the sternum. In the intercostal neurovascular space near the sternum, the anterior cutaneous and the collateral branch of the intercostal nerve from T1 to T6 are located and innervate the sternum and the skin around the sternum. Therefore, parasternai intercostal nerve block, a technique of injecting local anesthetic into the intercostal neurovascular space near the sternum is indicated for midline sternotomy and sternal fracture. As for ultrasound guided technique, the internal mammary artery and the transverse thoracic muscle are a good landmark to detect the intercostal neurovascular space near the sternum. Here, I would like to share the technique of parasternal intercostal nerve block.
OPT14-001 Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso. Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose in Water (D5W) as the Primary Hydrodissection King Hei Stanley Lam,1 Kenneth Dean Reeves,2 An Lin Cheng3 1 Department of Family Medicine, Chinese University of Hong Kong, Hong Kong, 2Department of Physical Medicine and Rehabilitation., University of Kansas, Kansas, United States, 3Department of Biomedical and Health Informatics, University of Missouri-Kansas City, School of Medicine, United States Objectives: Although low-level studies demonstrate effectiveness of nerve hydrodissection, there are no high level studies to date.4 Prior to high-level study performance, procedural methods must be described that are reproducibly performed, reliable in effect, and safe. The objectives of this article are to