As hospitals and surgery centres navigate to resume elective and non-urgent surgical procedure volumes, there is heightened concern that the continued use of opioids for pain management before, during and after a procedure may perpetuate the current rise in opioid-related deaths. Similarly, the use of general anaesthesia potentially exposes physicians and staff to viral contamination when intubating a patient, releasing aerosols and droplets, which is a primary mode of transmission of COVID-19.
Although there is no one simple solution to address the public health issues of the opioid epidemic along with the COVID-19 pandemic, there is a technique that can reduce the likelihood of both addiction and viral transmission associated with surgical procedures: regional anaesthesia.
J. Douglas Jaffe, DO, an anaesthesiologist specializing in regional anaesthesia and acute pain management, says: “There is a substantial benefit to reducing the number of aerosol-generating procedures, such as intubation and extubation, when utilizing regional techniques for perioperative management in lieu of a general anaesthetic. We have also seen an increase in the acceptance, by both surgeons and patients, of spinal anaesthesia for the same reasons.”
Regional anaesthesia is a safe and effective type of pain management that doesn’t involve the potential side effects and complications of general anaesthesia and sedation.
Ultrasound guidance is instrumental in the growing adoption of regional anaesthesia and analgesia by many anaesthesiologists. Studies suggest increased success, decreased complication rates, reduced time and greater patient comfort in ultrasound guided peripheral nerve block injections.
Dr Jaffe has also seen a marked increase in the utilization of ultrasound at the point of care for use in regional anaesthesia and analgesia. “Espousing the proven benefits of the use of ultrasound, which include reduced risk of vascular trespass and improved patient comfort and tolerance, otherwise reluctant patients who would have declined a regional technique are increasingly accepting,” Dr Jaffe explains.
There is a substantial benefit to reducing the number of aerosol generating procedures, such as intubation and extubation, when utilizing regional techniques
for perioperative management in lieu of a general anaesthetic. We have also seen an increase in the acceptance, by both surgeons and patients, of spinal anaesthesia for the same reasons.
Ultrasound visualization
Using ultrasound, the anaesthesiologist can locate important anatomy, such as the median nerve, ulnar nerve, radial nerve, etc., and visualize the needle as it enters the field of view, enters the nerve to deliver the block and visualize the spread of the local anaesthetic inside the region of interest.
So which ultrasound system features are critical when using it for regional anaesthesia?
Needle visualization is clearly key, but not all systems provide the same quality of needle visibility.
Algorithms that utilize both in-plane and out-of-plane methods to improve needle visibility (both the tip and the shaft), especially in steep angle approaches, enable increased accuracy in needle placement.
Superior image quality that enhances signal penetration, improves resolution and increases colour flow sensitivity al- lows for detailed tissue differentiation and detection of small structures. An ultrasound probe that offers a trapezoid view, which extends the field of view, high sensitivity for scanning both deep and superficial structures and provides a small footprint to reach difficult to access areas and manoeuvre around the area of interest facilitates a more efficient regional anaesthesia injection.
The SONIMAGE® HS1 from Konica Minolta Healthcare meets all of these requirements for rapid and confident ultrasound guided regional anaesthesia and pain management procedures.
Regional anaesthesia delivers numerous benefits to patients and staff compared to general anaesthesia, including reduced need for opioids, no airway manipulation that could release viral aerosols, fewer complications and adverse events leading to less dependence on critical care services for patients, and faster time to discharge. Ultrasound guidance is key to successful implementation of a regional anaesthesia service.
