Taylan AKKAYA, Alp ALPTEKİN, Derya ÖZKAN

Ultrason eşliğinde kronik ağrı girişimleri (2. bölüm)

Artık rejyonal anestezi pratiğinde ultrasonografi (US) vazgeçilmez yardımcı görüntüleme tekniği olarak yerini almıştır. Ultrasonografi ile kas/iskelet, periferik ve nöraksial bölgelerin kronik ağrılı patolojilerde çeşitli invaziv girişimler yapmak olasıdır. Bu girişimler diagnostik bloklar, radyofrekans uygulamaları ve nörolitik ajanların uygulamaları olarak özetlenebilirler. Algolojik girişimler esnasında US; hedef dokuların görüntülenmesinde, uygulanan ilacın yayılımında, çevredeki vasküler yapıların görüntülenmesinde büyük kolaylıklar sağlar. Ayrıca US ile floroskopi ve bilgisayarlı tomografi uygulamaları esnasındaki radyasyon yayılımı söz konusu değildir. Kronik ağrı girişimlerinde US ile yayınlanan klinik çalışmalar umut vericidir. Ayrıca son yıllarda bu alandaki gelişmeler (ekojen iğneler, üç boyutlu US cihazları vd.) US'nin algoloji pratiğindeki kullanımının daha da yaygınlaşacağını düşündürmektedir. Bu derlemenin amacı, US eşliğinde yapılan çeşitli kronik ağrı girişimlerini gözden geçirmektir.

Ultrasound guided chronic pain interventions (Part II)

Henceforth, ultrasonography (US) is an indispensible imaging technique in regional anesthesia practice. With the guidance of US, various invasive interventions in chronic pain pathologies of the musculoskeletal system, peripheral and neuroaxial pathologies has become possible. The management includes diagnostic blocks as weel as radiofrequency ablation and institution of neurolythic agents. During these algologic interventions we are able to see the target tissue, the dispersion of the drug and all nearby vascular structures. Besides these the US also protects the team from ionic radiation that one encounters when using flouroscopy of computed tomography. Latest publication in this field show that applicability of US in chronic pain syndromes is rapidly expanding with a good future. The additional equipment (echogenic needles, 3-D US etc.) will also expands its applications in algology practice. This review highlights different applications of US in chronic pain conditions.

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1. Giordano BD, Baumhauer JF, Morgan TL, Rechtine GR. Cervical spine imaging using standard C-arm fluoroscopy: patient and surgeon exposure to ionizing radiation. Spine (Phila Pa 1976) 2008;33(18):1970-6.
2. Finlayson RJ, Etheridge JP, Vieira L, Gupta G, Tran DQ. A randomized comparison between ultrasound- and fluoroscopy-guided third occipital nerve block. Reg Anesth Pain Med 2013;38(3):212-7.
3. Obernauer J, Galiano K, Gruber H, Bale R, Obwegeser AA, Schatzer R, et al. Ultrasound-guided versus Computed Tomography-controlled facet joint injections in the middle and lower cervical spine: a prospective randomized clinical trial. Med Ultrason 2013;15(1):10-5.
4. Narouze SN, Vydyanathan A, Kapural L, Sessler DI, Mekhail N. Ultrasound-guided cervical selective nerve root block: a fluoroscopy-controlled feasibility study. Reg Anesth Pain Med 2009;34(4):343-8.
5. Cohen SP, Strassels SA, Kurihara C, Forsythe A, Buckenmaier CC 3rd, McLean B, et al. Randomized study assessing the accuracy of cervical facet joint nerve (medial branch) blocks using different injectate volumes. Anesthesiology 2010;112(1):144-52.
6. Narouze SN. Ultrasound-guided interventional procedures in pain management: Evidence-based medicine. Reg Anesth Pain Med 2010;35(2 Suppl):55-8.
7. Martinoli C, Bianchi S, Santacroce E, Pugliese F, Graif M, Derchi LE. Brachial plexus sonography: a technique for assessing the root level. AJR Am J Roentgenol 2002;179(3):699- 702.
8. Bruneau M, Cornelius JF, Marneffe V, Triffaux M, George B. Anatomical variations of the V2 segment of the vertebral artery. Neurosurgery 2006;59(1 Suppl 1):ONS20-4; discussion ONS20-4.
9. Narouze SN, Provenzano DA. Sonographically guided cervical facet nerve and joint injections: why sonography? J Ultrasound Med 2013;32(11):1885-96.
10. Narouze S. Ultrasound-guided cervical facet intraarticular injections. Tech Reg Anesth Pain Manage 2009;13:133-6.
11. Narouze S, Peng PW. Ultrasound-guided interventional procedures in pain medicine: a review of anatomy, sonoanatomy, and procedures. Part II: axial structures. Reg Anesth Pain Med 2010;35(4):386-96.
12. Eichenberger U, Greher M, Kapral S, Marhofer P, Wiest R, Remonda L, et al. Sonographic visualization and ultrasoundguided block of the third occipital nerve: prospective for a new method to diagnose C2-C3 zygapophysial joint pain. Anesthesiology 2006;104(2):303-8.
13. Finlayson RJ, Etheridge JP, Vieira L, Gupta G, Tran DQ. A randomized comparison between ultrasound- and fluoroscopy-guided third occipital nerve block. Reg Anesth Pain Med 2013;38(3):212-7.
14. Gofeld M, Bhatia A, Abbas S, Ganapathy S, Johnson M. Development and validation of a new technique for ultrasound-guided stellate ganglion block. Reg Anesth Pain Med 2009;34(5):475-9.
15. Narouze S. Ultrasound-guided stellate ganglion block: safety and efficacy. Curr Pain Headache Rep 2014;18(6):424.
16. Groeben H. Epidural anesthesia and pulmonary function. J Anesth 2006;20(4):290-9.
17. Gray H. Anatomy of the Human Body, 20th ed. Philadelphia: Lea & Febiger; 1918; Bartleby.com, 2000. Available from URL: http://www.bartleby.com/107/.
18. Broadbent CR, Maxwell WB, Ferrie R, Wilson DJ, GawneCain M, Russell R. Ability of anaesthetists to identify a marked lumbar interspace. Anaesthesia 2000;55(11):1122- 6.
19. Arzola C, Avramescu S, Tharmaratnam U, Chin KJ, Balki M. Identification of cervicothoracic intervertebral spaces by surface landmarks and ultrasound. Can J Anaesth 2011;58(12):1069-74.
20. Carnie J, Boden J, Gao Smith F. Prediction by computerised tomography of distance from skin to epidural space during thoracic epidural insertion. Anaesthesia 2002;57(7):701-4.
21. Avramescu S, Arzola C, Tharmaratnam U, Chin KJ, Balki M. Sonoanatomy of the thoracic spine in adult volunteers. Reg Anesth Pain Med 2012;37(3):349-53.
22. American Society of Anesthesiologists Task Force on Chronic Pain Management; American Society of Regional Anesthesia and Pain Medicine. Practice guidelines for chronic pain management: an updated report by the American Society of Anesthesiologists Task Force on Chronic Pain Management and the American Society of Regional Anesthesia and Pain Medicine. Anesthesiology 2010;112(4):810-33.
23. Karmakar MK, Li X, Ho AM, Kwok WH, Chui PT. Realtime ultrasound-guided paramedian epidural access: evaluation of a novel in-plane technique. Br J Anaesth 2009;102(6):845-54.
24. Karmakar MK, Li X, Kwok WH, Ho AM, Ngan Kee WD. Sonoanatomy relevant for ultrasound-guided central neuraxial blocks via the paramedian approach in the lumbar region. Br J Radiol 2012;85(1015):262-9.
25. Sahota JS, Carvalho JC, Balki M, Fanning N, Arzola C. Ultrasound estimates for midline epidural punctures in the obese parturient: paramedian sagittal oblique is comparable to transverse median plane. Anesth Analg 2013;116(4):829-35.
26. Evansa I, Logina I, Vanags I, Borgeat A. Ultrasound versus fluoroscopic-guided epidural steroid injections in patients with degenerative spinal diseases: a randomised study. Eur J Anaesthesiol 2015;32(4):262-8.
27. Küllmer K, Rompe JD, Löwe A, Herbsthofer B, Eysel P. Ultrasound image of the lumbar spine and the lumbosacral transition. Ultrasound anatomy and possibilities for ultrasonically-controlled facet joint infiltration. [Article in German] Z Orthop Ihre Grenzgeb 1997;135(4):310-4. [Abstract]
28. Gofeld M, Bristow SJ, Chiu S. Ultrasound-guided injection of lumbar zygapophyseal joints: an anatomic study with fluoroscopy validation. Reg Anesth Pain Med 2012;37(2):228-31.
29. Galiano K, Obwegeser AA, Walch C, Schatzer R, Ploner F, Gruber H. Ultrasound-guided versus computed tomography-controlled facet joint injections in the lumbar spine: a prospective randomized clinical trial. Reg Anesth Pain Med 2007;32(4):317-22.
30. Greher M, Kirchmair L, Enna B, Kovacs P, Gustorff B, Kapral S, et al. Ultrasound-guided lumbar facet nerve block: accuracy of a new technique confirmed by computed tomography. Anesthesiology 2004;101(5):1195-200.
31. Shim JK, Moon JC, Yoon KB, Kim WO, Yoon DM. Ultrasoundguided lumbar medial-branch block: a clinical study with fluoroscopy control. Reg Anesth Pain Med 2006;31(5):451- 4.
32. Rauch S, Kasuya Y, Turan A, Neamtu A, Vinayakan A, Sessler DI. Ultrasound-guided lumbar medial branch block in obese patients: a fluoroscopically confirmed clinical feasibility study. Reg Anesth Pain Med 2009;34(4):340-2.
33. Simpson G, Nicholls B. Use of ultrasound in chronic pain medicine. Part 1: neuraxial and sympathetic blocks. Cont Educ Anaesth, Crit Care & Pain 2013;13(5):145.
34. Loizides A, Gruber H, Peer S, Brenner E, Galiano K, Obernauer J. A new simplified sonographic approach for pararadicular injections in the lumbar spine: a CT-controlled cadaver study. AJNR Am J Neuroradiol 2011;32(5):828-31.
35. Loizides A, Gruber H, Peer S, Galiano K, Bale R, Obernauer J. Ultrasound guided versus CT-controlled pararadicular injections in the lumbar spine: a prospective randomized clinical trial. AJNR Am J Neuroradiol 2013;34(2):466-70.
36. Blanchais A, Le Goff B, Guillot P, Berthelot JM, Glemarec J, Maugars Y. Feasibility and safety of ultrasound-guided caudal epidural glucocorticoid injections. Joint Bone Spine 2010;77(5):440-4.
37. Pekkafahli MZ, Kiralp MZ, Başekim CC, Silit E, Mutlu H, Oztürk E, et al. Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 2003;22(6):553-9.
38. Klauser A, De Zordo T, Feuchtner G, Sögner P, Schirmer M, Gruber J, et al. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 2008;59(11):1618-24.
39. Maurits NM, Bollen AE, Windhausen A, De Jager AE, Van Der Hoeven JH. Muscle ultrasound analysis: normal values and differentiation between myopathies and neuropathies. Ultrasound Med Biol 2003;29(2):215-25.