"Ultrasound-Guided Pain Injection Therapy" Reading Notes

Ultrasound Fundamentals By Danni & Cat & Miao Chisound technology applies an ultrasound instrument to send ultrasonic waves to the human body, and uses the transmission, reflection, refraction, diffraction, attenuation, and absorption of sound waves to generate information, and then performs image processing through the ultrasound instrument, and then displays the ultrasound on the screen.
Anatomical sonogram
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Ultrasound guidance technology is a technology for various puncture and treatment under the guidance of ultrasound positioning, which can be used for the diagnosis and treatment of pain.
The ultrasonic instrument is mainly composed of a host, a probe and various accessories.
The host: the host has a processor with a display Probe: According to different classification methods, ultrasonic probes have different types: according to the frequency of ultrasonic waves, they can be divided into low-frequency probes and high-frequency probes; according to their shapes, they can be divided into linear array probes and convex array probes
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The uses and characteristics of various probes in pain diagnosis and treatment are different.
The position of the probe and the scanning direction of the probe are divided into median, coronal, sagittal (parasagittal) and Axial position
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The long axis of the ultrasonic probe or ultrasonic beam is relative to the target structure of puncture or injection, and the scanning mode is divided into two types: short axis and long axis, median (red), sagittal (yellow), coronal (blue), transverse or Axial (green) Ultrasound scanning method Ultrasound-guided puncture techniques and types can be divided into in-plane and out-of-plane puncture techniques according to the relative positions of the puncture needle and the ultrasonic probe.
The posture can improve the stability of the ultrasound probe and the coordination of mobility: the little finger or the ulnar side of the hand is close to the patient to hold the ultrasound method more stably.
can improve the contact area between the puncture needle and the ultrasonic beam (2) thickening the puncture needle and rough surface of the puncture needle can improve the display of the needle (3) slightly moving the puncture needle can help to observe the position of the puncture needle (4) can Injection of a small amount of liquid to locate the needle tip (5) Application of ultrasound contrast agent (6) Combined use of nerve stimulators can help to explore the location of nerves.
Diagnosis and treatment technical points (1) Proficient in the anatomy of each path (2) Proficient in each path.
The anatomical structure of the ultrasound section (3) Familiar with the basic principles of ultrasound (4) Trained to be skilled in hand-eye coordination operation (5) According to the target positioning, select the appropriate ultrasound probe, scanning method and puncture technique (6) Avoid the puncture path important organs such as blood vessels, kidneys, etc.
(7) The puncture needle, especially the position of the needle tip, is displayed during the puncture process to ensure safety (8) When injecting drugs and sclerosing agents, closely observe the diffusion of the drugs.
Ultrasound of nerves, muscles, and blood vessels Image features (1) The three trunks of nerve trunks, such as the brachial plexus, are hypoechoic round or oval structures in cross section, and some nerve bundles are also surrounded by hyperechoic nerve sheaths; the cross sections of some nerves are shown as It is hyperechoic and needs to be differentiated from other connective tissues
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The cross-sections of nerves close to the periphery are mostly honeycomb (2) The cross-sections of muscles and tendons are sometimes difficult to identify with nerves, especially in the elderly, so careful identification is required based on sonography and anatomy
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The muscles are converging on the vertical axis and punctate on the horizontal axis
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Tendons are attached to bones and muscles, and depending on this anatomical relationship, (3) arteries and veins are hypoechoic structures
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Arteries can be judged by their pulsations, and veins are generally squashed by a pressing probe
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A more reliable method is to use color Doppler ultrasonography, the blood vessels are colored and the nerves have no local injection of drugs (1) local anesthetics should be used as far as possible.
Local anesthetics with sensorimotor block separation, such as bupivacaine, ropiper Caine, with a concentration of 0.
1% to 0.
2% (2) Peripheral injection of glucocorticoids should choose a suspension as much as possible, such as triamcinolone acetonide and compound betamethasone suspension, to prolong the local action time and reduce systemic absorption
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In order to reduce the effect on blood pressure and blood sugar, patients with hypertension and diabetes should reduce the dose appropriately (3) Platelet-rich plasma is centrifuged at high speed of peripheral whole blood to separate the plasma of platelets and inject it into the injured tendon or tissue.
In the joint cavity of damaged cartilage, it can promote the repair of tendon or cartilage.
Complications and adverse reactions (1) Accidental puncture and accidental injury caused by unskilled puncture techniques are the most serious complications, such as penetrating the vertebral artery by mistake, penetrating the spinal canal (2) Adverse reactions of drugs including glucocorticoid-induced increase in blood pressure and blood sugar, electrolyte and endocrine dysfunction, etc.