Cover

Sonoanatomy for Anaesthetists

Title

Copyright

CONTENTS

PREFACE

INTRODUCTION

Getting the best scan

Choosing a probe

Choosing the frequency

Gain control

Depth

Focus

Identifying the anatomy in a scan

Gross anatomy

Scan landmarks

Tracking

Anisotropy

Recognizing different tissues in an ultrasound scan

Nerves

Tendons

Muscle

Bone

Blood vessels

Post-cystic enhancement

Uses of ultrasound in procedures

Guiding the needle in regional anaesthesia

Obtaining a good view of the needle

In-plane and out-of-plane needling techniques

Observation of local anaesthetic spread

Checking perineural catheter placement

Guiding intravascular cannulation

Section 1: UPPER LIMB

SUPRASCAPULAR NERVE

Anatomy of the suprascapular nerve

Probe placement for suprascapular nerve block

Scan of suprascapular notch

Diagram of scan

SUPRACLAVICULAR BRACHIAL PLEXUS

Anatomy of the supraclavicular brachial plexus

Probe placement for supraclavicular brachial plexus block

Scan of supraclavicular brachial plexus

Diagram of scan

INTERSCALENE BRACHIAL PLEXUS

Anatomy of the interscalene brachial plexus

Probe placement for interscalene brachial plexus block

Scan of interscalene brachial plexus

Diagram of scan

INFRACLAVICULAR BRACHIAL PLEXUS

Anatomy of the infraclavicular brachial plexus

Probe placement for infraclavicular brachial plexus block

Scan of infraclavicular brachial plexus

Diagram of scan

AXILLARY BRACHIAL PLEXUS

Anatomy of the axillary brachial plexus

Probe placement for axillary brachial plexus block

Scan of axillary brachial plexus

Diagram of scan

RADIAL NERVE IN THE UPPER ARM

Anatomy of the radial nerve in the upper arm

Probe placement for radial nerve block in upper arm

Scan of radial nerve in upper arm

Diagram of scan

MEDIAL CUTANEOUS NERVE OF THE FOREARM

Anatomy of the medial cutaneous nerve of the forearm

Probe placement for block of medial cutaneous nerve of forearm

Scan of medial cutaneous nerve of forearm

Diagram of scan

LATERAL CUTANEOUS NERVE OF THE FOREARM

Anatomy of the lateral cutaneous nerve of the forearm

Probe placement for block of lateral cutaneous nerve of forearm

Scan of lateral cutaneous nerve of forearm

Diagram of scan

MEDIAN NERVE IN THE CUBITAL FOSSA

Anatomy of the median nerve in the cubital fossa

Probe placement for median nerve block in cubital fossa

Scan of median nerve in cubital fossa

Diagram of scan

MEDIAN NERVE IN THE FOREARM

Anatomy of the median nerve in the forearm

Probe placement for median nerve block in forearm

Scan of median nerve in forearm

Diagram of scan

ULNAR NERVE IN THE FOREARM

Anatomy of the ulnar nerve in the forearm

Probe placement for ulnar nerve block in forearm

Scan of ulnar nerve in forearm

Diagram of scan

SUPERFICIAL RADIAL NERVE IN THE FOREARM

Anatomy of the superficial radial nerve in the forearm

Probe placement for superficial radial nerve block in forearm

Scan of superficial radial nerve in forearm

Diagram of scan

MEDIAN NERVE AT THE WRIST

Anatomy of the median nerve at the wrist

Probe placement for median nerve block at wrist

Scan of median nerve at wrist

Diagram of scan

ULNAR NERVE AT THE WRIST

Anatomy of the ulnar nerve at the wrist

Probe placement for ulnar nerve block at wrist

Scan of ulnar nerve at wrist

Diagram of scan

Section 2: LOWER LIMB

FEMORAL NERVE

Anatomy of the femoral nerve

Probe placement for femoral nerve block

Scan of femoral nerve

Diagram of scan

LATERAL CUTANEOUS NERVE OF THE THIGH

Anatomy of the lateral cutaneous nerve of the thigh

Probe placement for block of lateral cutaneous nerve of thigh

Scan of lateral cutaneous nerve of thigh

Diagram of scan

OBTURATOR NERVE

Anatomy of the obturator nerve

Probe placement for obturator nerve block

Scan of obturator nerve

Diagram of scan

SCIATIC NERVE AT THE GLUTEAL FOLD

Anatomy of the sciatic nerve in the gluteal region

Probe placement for sciatic nerve block at gluteal fold

Scan of sciatic nerve at gluteal fold

Diagram of scan

TIBIAL NERVE IN THE POPLITEAL FOSSA

Anatomy of the tibial nerve in the popliteal fossa

Probe placement for tibial nerve block in popliteal fossa

Scan of tibial nerve in popliteal fossa

Diagram of scan

POSTERIOR CUTANEOUS NERVE OF THE THIGH

Anatomy of the posterior cutaneous nerve of the thigh

Probe placement for block of posterior cutaneous nerve of thigh

Scan of posterior cutaneous nerve of thigh

Diagram of scan

COMMON PERONEAL NERVE

Anatomy of the common peroneal nerve

Probe placement for common peroneal nerve block

Scan of common peroneal nerve

Diagram of scan

SAPHENOUS NERVE IN THE LOWER LEG

Anatomy of the saphenous nerve in the lower leg

Probe placement for saphenous nerve block in lower leg

Scan of saphenous nerve in lower leg

Diagram of scan

SURAL NERVE IN THE CALF

Anatomy of the sural nerve in the calf

Probe placement for sural nerve block in calf

Scan of sural nerve in calf

Diagram of scan

POSTERIOR TIBIAL NERVE IN THE LOWER LEG

Anatomy of the posterior tibial nerve in the lower leg

Probe placement for posterior tibial nerve block in lower leg

Scan of posterior tibial nerve in lower leg

Diagram of scan

DEEP PERONEAL NERVE

Anatomy of the deep peroneal nerve

Probe placement for deep peroneal nerve block

Scan of deep peroneal nerve

Diagram of scan

SUPERFICIAL PERONEAL NERVE

Anatomy of the superficial peroneal nerve

Probe placement for superficial peroneal nerve block

Scan of superficial peroneal nerve

Diagram of scan

SAPHENOUS NERVE IN THE THIGH

Anatomy of the saphenous nerve in the thigh

Probe placement for saphenous nerve block in thigh

Scan of saphenous nerve in thigh

Diagram of scan

SURAL NERVE IN THE LOWER LEG

Anatomy of the sural nerve in the lower leg

Probe placement for sural nerve block in lower leg

Scan of sural nerve in lower leg

Diagram of scan

POSTERIOR TIBIAL NERVE AT THE ANKLE

Anatomy of the posterior tibial nerve at the ankle

Probe placement for posterior tibial nerve block at ankle

Scan of posterior tibial nerve at ankle

Diagram of scan

SURAL NERVE AT THE ANKLE

Anatomy of the sural nerve at the ankle

Probe placement for sural nerve block at ankle

Scan of sural nerve at ankle

Diagram of scan

Section 3: BACK

LUMBAR SPINE

The lumbar spine

Median plane

Juxtamedian plane

Lumbosacral junction

Probe placement over the lumbosacral junction

Juxtamedian scan of lumbosacral junction

Diagram of scan

L3–L4 intervertebral space

Probe placement over L3–L4 intervertebral space

Juxtamedian scan of L3–L4 intervertebral space

Diagram of scan

Longitudinal view of facet joints at L3 and L4

Probe placement for paramedian view of facet joints at L3 and L4

Scan of lumbar facet joints at L3 and L4

Diagram of scan

Transverse view of L3–L4 intervertebral space

Probe placement for transverse view of L3–L4 intervertebral space

Transverse scan of L3–L4 intervertebral space

Diagram of scan

LUMBAR PLEXUS

Anatomy of the lumbar plexus

Probe placement for lumbar plexus block

Scan of psoas compartment for lumbar plexus block

Diagram of scan

THORACIC SPINE

Juxtamedian (longitudinal) view of the thoracic spine

Probe placement to view thoracic ligamentum flavum

Juxtamedian scan at T6 and T7

Diagram of scan

Transverse view of thoracic spine

Probe placement for transverse scan of thoracic spine

Transverse scan at T6–T7

Diagram of scan

Paravertebral scan through thoracic transverse processes

Probe placement for paravertebral scan through thoracic transverse processes

Paravertebral scan through transverse processes at T6 and T7

Diagram of scan

THORACIC PARAVERTEBRAL SPACE

Anatomy of the thoracic paravertebral space

Probe placement for thoracic paravertebral block

Scan of thoracic paravertebral space

Diagram of scan

CERVICAL SPINE

Juxtamedian (longitudinal) view of the cervical spine

Probe placement for juxtamedian scan at C5–C6

Juxtamedian scan of cervical spine

Diagram of scan

Transverse view of cervical spine

Probe placement for transverse scan at C5–C6

Transverse scan of cervical spine at C5

Diagram of scan

MEDIAL BRANCHES OF THE POSTERIOR PRIMARY RAMUS

Medial branches of the posterior rami of cervical spinal nerves

Probe placement for block of medial branch of posterior ramus

Scan of C5 articular pillar in cervical spine

Diagram of scan

SACRUM

Anatomy of the sacrum

Probe placement for longitudinal view of sacral cornua

Longitudinal scan of intermediate crest and sacral cornua

Diagram of scan

Transverse view of the sacral cornua

Probe placement for transverse scan of sacral cornua and sacral hiatus

Transverse scan of sacral cornua

Diagram of scan

ULTRASOUND IN THE LUMBAR EPIDURAL

Using ultrasound in a lumbar epidural injection

Prescans for lumbar epidural

Low-frequency juxtamedian prescan for lumbar epidural

Low-frequency transverse prescan for lumbar epidural

Section 4: HEAD AND NECK

GREATER OCCIPITAL NERVE

Anatomy of the greater occipital nerve

Probe placement for greater occipital nerve block

Scan of greater occipital nerve

Diagram of scan

GREATER AURICULAR NERVE

The greater auricular nerve

Probe placement for greater auricular nerve block

Scan of greater auricular nerve

Diagram of scan

SUPERFICIAL CERVICAL PLEXUS

Anatomy of the superficial cervical plexus

Probe placement for superficial cervical plexus block

Scan of superficial cervical plexus

Diagram of scan

CERVICAL PLEXUS

Anatomy of the cervical plexus

Probe placement for cervical plexus block

Scan of deep cervical plexus (C4 primary posterior ramus)

Diagram of scan

STELLATE GANGLION

Anatomy of the stellate ganglion

Probe placement for stellate ganglion block

Scan of stellate ganglion

Diagram of scan

Section 5: ABDOMEN

SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE (TAP)

Anatomy of the subcostal TAP nerves (T7–T10)

Probe placement for subcostal TAP block

Scan of subcostal TAP

Diagram of scan

LOWER TRANSVERSUS ABDOMINIS PLANE (TAP)

Anatomy of the lower TAP nerves

Probe placement for lower TAP block

Scan of lower TAP

Diagram of scan

ILIOINGUINAL AND ILIOHYPOGASTRIC NERVES

Anatomy of the Ilioinguinal and iliohypogastric nerves

Probe placement for ilioinguinal and iliohypogastric nerve block

Scan of ilioinguinal and iliohypogastric nerves

Diagram of scan

RECTUS SHEATH

Anatomy of the rectus sheath nerves (T8–L1)

Probe placement for rectus sheath block

Scan of lateral border of rectus sheath

Diagram of scan

GENITOFEMORAL NERVE

Anatomy of the genitofemoral nerve

Probe placement for block of genital branch of genitofemoral nerve

Scan of spermatic cord and genitofemoral nerve

Diagram of scan

Section 6: VASCULAR ACCESS

INTERNAL JUGULAR VEIN

Anatomy of the internal jugular vein

Probe placement for cannulation of internal jugular vein

Transverse scan of internal jugular vein

Diagram of scan

FEMORAL VEIN

Anatomy of the femoral vein

Probe placement for femoral venipuncture

Scan of femoral vein

Diagram of scan

RADIAL ARTERY

Anatomy of the radial artery

Probe placement for radial artery puncture

Scan of radial artery

Diagram of scan

SUBCLAVIAN VEIN

Anatomy of the subclavian vein

Probe placement for cannulation of subclavian vein

Scan of subclavian vein

Diagram of scan