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Brown: Atlas of Regional Anesthesia, 3rd ed., Copyright © 2006 Saunders, An Imprint of Elsevier
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ULTRASONOGRAPHY

In recent years, there has been growing interest in the development of image-guided peripheral nerve blocks. A variety of techniques have been utilized. Magnetic resonance imaging and computed tomographic scanning provide excellent anatomic images but are expensive and inaccessible to the routine operating room. Fluoroscopy is more readily available but is able only to demonstrate bony landmarks and outlines of radiopaque contrast administered via the needle or catheter. Ultrasonographic imaging devices are noninvasive, portable, and moderately priced. Most work has been done using scanning probes with frequencies in the range of 5 to 10 MHz. These devices are capable of identifying vascular and bony structures but not nerves. Contemporary devices using high resolution probes (12–15 MHz) and compound imaging allow clear visualization of nerves, vessels, catheters, and local anesthetic injection and can potentially improve the techniques of ultrasound-assisted peripheral nerve block. Use of these devices is limited by their cost, the need to be trained in their use and to become familiar with ultrasonographically imaged anatomy, and the extra set of hands required. They work best with superficial nerve plexi and may be limited by excessive obesity or anatomically distant structures. I (d.l.b.) continue to believe that this area of regional anesthesia practice is a fruitful one for further systematic research.

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