American Society of Regional Anesthesia and Pain Medicine August 2016 - 28

and needle tip location must be analyzed and understood in
three planes of view. The probes used for 3D and 4D ultrasound
have larger footprints compared with the 2D probes and may
not be practical for use in some anatomic locations. With larger
probes, maintaining probe-to-patient contact and allowing for
needle approach may be challenging. The lower frequencies
of matrix array probes sacrifice image resolution and degrade
image quality. The higher cost of the machine and probe, at least
for now, is another factor to consider and may be prohibitive for
some practices. As a result, the use of 3D and 4D ultrasound in
regional anesthesia may not expand as fast as has occurred with
2D ultrasonography. 12
In conclusion, the practice of regional anesthesia has seen
significant positive changes in the past 10 years with the
widespread use of 2D ultrasonography. As technological advances
in ultrasound imaging continue, new modalities such as 3D and
4D ultrasound are being used. The new technology can help us
enhance our understanding of neural and perineural anatomy,
shed more light on perineural catheter placement techniques,
and determine LA dose and volume requirements (ED95, EV95) and
its optimal spread pattern. However, the need for more advanced
training, large probe size and footprint, lower resolution in matrix
probes, and cost of equipment may render the technology less
appealing in everyday clinical practice.
REFERENCES
1.

28
2

Neal JM, Brull R, Chan VW, et al. The ASRA evidence-based medicine
assessment of ultrasound-guided regional anesthesia and pain medicine;
executive summary. Reg Anesth Pain Med. 2010;35:S1-S9.

French JLH, Raine-Fenning NJ, Hardman JG, Bedforth NM. Pitfalls of ultrasound
guided vascular access: the use of three/four-dimensional ultrasound.
Anaesthesia. 2008;63:806-813.

Marhofer D, Karmakar MK, Marhofer P, Kettner SC, Weber M, Zeitlinger M. Does
circumferential spread of local anaesthetic improve the success of peripheral
nerve block? Br J Anaesth. 2014;113(1):177-185.

Karmakar M, Li X, Li J, Sala-Blanch X, Hadzic A, Gin T. Three-dimensional/fourdimensional volumetric ultrasound imaging of the sciatic nerve. Reg Anesth Pain
Med. 2012;37:60-66.

Karmakar MK, Li X, Li J, Hadzic A. Volumetric three-dimensional ultrasound
imaging of the anatomy relevant for thoracic paravertebral block. Anesth Analg.
2012;115:1246-1250.

Foxall GL, Hardman JG, Bedforth NM. Three-dimensional, multiplanar,
ultrasound-guided, radial nerve block. Reg Anesth Pain Med. 2007;32:516-521.

Feinglass NG, Clendenen SR, Torp KD, Wang RD, Castello R, Greengrass RA.
Real-time three-dimensional ultrasound for continuous popliteal blockade: a
case report and image description. Anesth Analg. 2007;105:272-274.

Missair A, Weisman RS, Suarez MR, Yang R, Gebhard RE. A 3-dimensional
ultrasound study of local anesthetic spread during lateral popliteal nerve block:
what is the ideal end point for needle tip position? Reg Anesth Pain Med.
2012;37:627-632.

Brull R, Macfarlane AJR, Parrington SJ, Kishkin A, Chan VWS. Is circumferential
injection advantageous for ultrasound-guided popliteal sciatic nerve block? A
proof-of-concept study. Reg Anesth Pain Med. 2011;36:266-270.

10. Al-Nasser B, Hubert C, Negre M. Role of local anesthetic spread pattern and
electrical stimulation in ultrasound-guided musculocutaneous nerve block. J
Clin Anesth. 2010;22:334-339.
11. Eichenberger U, StÖckli S, Marhofer P, et al. Minimal local anesthetic volume
for peripheral nerve block: a new ultrasound-guided, nerve dimension-based
method. Reg Anesth Pain Med. 2009;34:242-246.
12. Helen L, O'Donnell BD, Moore E. Nerve localization techniques for peripheral
nerve block and possible future directions. Acta Anaesth Scand. 2015;59:962-
974.

American Society of Regional Anesthesia and Pain Medicine
2016

Table of Contents for the Digital Edition of American Society of Regional Anesthesia and Pain Medicine August 2016