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Drs. Charles Brunson, Chris Kinard and Christina Saulny demonstrate an ultrasound-guided nerve block at UMC’s Day Surgery Center.

The technology itself may be half a century old — but a fresh application for it is changing the experience of applying local anesthetic for both surgical patients and their physicians.

Ultrasound-guided regional anesthetic blocks are a welcome shift in technique from the standard “blind” placement, say leaders in the University of Mississippi Medical Center’s Department of Anesthesiology. Among the technique’s advantages: increased safety for patients, longer relief from surgical pain and swifter mastery for physicians in training.

“Applying ultrasound to putting in local anesthetics means we can see the nerve structures beneath the skin and actually put our needle tip in the right place,” said Dr. Claude Brunson, chair and professor of anesthesiology.

“The technique we used before was ‘blind’ and you got better at it with experience. Now the learning curve is much shorter, and in a matter of months we can get trainees up to a level of skill that would have traditionally taken them years.”

Dr. Chris Kinard, assistant professor of anesthesiology and director of UMC’s Day Surgery Center, compared the ultrasound-guided skill of today’s residents to the 90 percent level of blind-technique accuracy he’s honed through 20 years of experience.

“It increases the safety as much as the success rate, because we know right where the needle is,” he said.

This new application for ultrasound comes about not through changes in the technology itself, but rather as ultrasound devices have become portable and inexpensive enough to be used at the bedside, Brunson said.

At the Day Surgery Center, the ultrasound machine is the size of a laptop computer and can be toted around on a cart. To use the machine at a patient’s bedside, an anesthesiologist glides the ultrasound imaging probe along the surface of the patient’s skin. The physician can watch on the screen as the needle meets the nerve.

Being able to apply just the right amount of pain medication at just the right point has benefits for patients both during and after surgery.

For some patients — particularly those with high-risk heart or lung diseases — the risk of undergoing anesthesia through inhaled gas is too high and therefore only local anesthetic is used in the operating room. For those patients, missing the mark in the local application can mean having to proceed with the riskier option of putting them to sleep with gas.

In rare cases, a misplaced needle can also result in damage to delicate nerves, Brunson said.

“Even though we don’t see that frequently, any of that risk we can cut down is better for the patient,” he said.

After surgery, patients continue to experience the benefits of perfectly placed local nerve blocks through prolonged pain management. When the nerve block works to prevent pain from occurring at the site of the surgical incision, patients have less need to take oral pain medications which work to numb the entire body. Patients have also had less anesthesia and therefore experience fewer side effects like nausea after surgery.

“We’re seeing patients get out of the hospital sooner because of better pain control,” Kinard said.

UMC and other major medical centers throughout the country have started introducing the technique since it first began appearing in medical literature three or four years ago, Brunson said. As many academic centers are still developing their curriculum for teaching the technique, it will likely emerge in broader practice in the coming years.

“We’re starting to train all our residents in the technique, and you’ll start to see it being used around Mississippi as these anesthesiologists-in-training begin their practices,” Brunson said. “At the same time, through continuing education, those already in practice will be able to learn the technique.”



August 2007

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