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ANALGESIA

Real-Time Three-Dimensional Ultrasound-Assisted Axillary Plexus Block Defines Soft Tissue Planes

Steven R. Clendenen, MD^*, Kevin Riutort, MD^*, Beth L. Ladlie, MD^*, Christopher Robards, MD^*, Carlo D. Franco, MD, and Roy A. Greengrass, MD^*

From the *Department of Anesthesiology, Mayo Clinic College of Medicine, Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida; Department of Anesthesiology and Anatomy, Rush University Medical Center; and Department of Anesthesiology, JHS Hospital of Cook County, Chicago, Illinois.

Address correspondence and reprint requests to Steven R. Clendenen, MD, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224. Address e-mail to clendenen.steven{at}mayo.edu.

Abstract

Two-dimensional (2D) ultrasound is commonly used for regional block of the axillary brachial plexus. In this technical case report, we described a real-time three-dimensional (3D) ultrasound-guided axillary block. The difference between 2D and 3D ultrasound is similar to the difference between plain radiograph and computer tomography. Unlike 2D ultrasound that captures a planar image, 3D ultrasound technology acquires a 3D volume of information that enables multiple planes of view by manipulating the image without movement of the ultrasound probe. Observation of the brachial plexus in cross-section demonstrated distinct linear hyperechoic tissue structures (loose connective tissue) that initially inhibited the flow of the local anesthesia. After completion of the injection, we were able to visualize the influence of arterial pulsation on the spread of the local anesthesia. Possible advantages of this novel technology over current 2D methods are wider image volume and the capability to manipulate the planes of the image without moving the probe.