American Society of Regional Anesthesia and Pain Medicine August 2016 - 26

Three- and Four-Dimensional Ultrasound-Guided Regional
Anesthesia: Are We There Yet?

T

he use of two-dimensional
(2D) ultrasound guidance
in regional anesthesia has
gained widespread acceptance
over the past 10 years.
Technological advancements in
ultrasound image acquisition
and processing have improved
both image resolution and
quality of display. Ultrasound
guidance as a technique
for nerve localization has
demonstrated many advantages
over the previously used electric
nerve stimulation technique.
These advantages include
shorter block performance
time, improved block quality,
decreased local anesthetic
(LA) dose requirements, and
more successful placement of
peripheral perineural catheters.1

data are processed and displayed in real time, a fourth dimension
(temporal) is added. This is referred to as four-dimensional (4D)
imaging.

Daniel B. Maalouf, MD, MPH
Assistant Attending Anesthesiologist
Department of Anesthesiology
Hospital for Special Surgery
Clinical Assistant Professor of
Anesthesiology
Weill Cornell Medical College, New
York, New York

Two types of transducers can be used for 3D and 4D imaging:
mechanically steered array probes or matrix array probes. When
mechanically steered probes are used, a scan acquiring 2D data
is moved along a selected area. The data are then processed
and presented as a scan of the collective volume of interest
(Figures 1-3). This is unlike 2D scanning, which shows only
a cross-sectional (short axis) or longitudinal view (long axis)
of the target nerve. In the mechanically steered array probe,

Figure 2: Short axis view in a volumetric scan of the axilla and proximal
arm.

Section Editor: Melanie Donnelly, MD

Three-dimensional (3D) ultrasound has been used in other
medical specialties; however, it is slowly making its way to the
anesthesia practice. As the technological advancements continue,
new frontiers are being explored. Three-dimensional ultrasound
imaging involves the acquisition of a volume of data that can later
be reviewed and manipulated. The acquisition of 3D data is done
as a large number of consecutive tomographic images are taken
through movements of an ultrasound transducer array (conventional
2D ultrasound probe). Each tomographic image is acquired with
its positional information to reconstruct a 3D data set. When 3D

Figure 1: Volumetric scan of the axilla and proximal arm.

26
2

Figure 3: Longitudinal view in a volumetric scan of axilla and proximal
arm showing the axillary vein, median and radial nerves.

American Society of Regional Anesthesia and Pain Medicine
2016



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