الفهرس 
HISTORICAL REVIEW OF THE USE OF ULTRASOUND IN REGIONAL ANESTHESIAOnly 14 pages are availabe for public view
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Abstract
P
alpation of the inter spinous space clinically was the only method to identify the point where you will apply neuroaxial blockade.and the loss-of-resistance technique is the standard approach to identify the epidural space during epidural anesthesia. Although it has been used for a long time, only about 60% of punctures are successful at the first attempt. Apart from the degree of personal experience, this high failure rate has been attributed to the quality of anatomical landmarks and of patient positioning. It may therefore be easier to identify the inter spinous space and the epidural space by ultrasonography whenever difficulties arise in connection with these variables.
Direct ultrasonographic visualization significantly improves the outcome of most techniques in neuroaxial blockade. With the help of high-resolution ultrasonography, the anesthetist can directly visualize inter spinous space anatomy. Such direct visualization improves the quality of neuroaxial blockade and avoids complications.
The benefits of directly visualizing targeted space and monitoring the distribution of local anesthetic are significant. In addition, ultrasound monitoring allows the anesthetist to reposition the needle in the event of maldistribution. It is therefore justified to expect anesthetists to acquire the skills to use ultrasound guidance in clinical practice. The technique can be established in a cost-efficient manner as portable ultrasound systems with high-frequency probes are now available. It is hoped that these systems will promote the routine use of ultrasound guidance in neuroaxial blockade.
Ultrasound technology will continue to evolve, providing further improvements in portability, ubiquity, image processing, and display. Similar to the computer and telephone industry, ultrasound equipment will likely become smaller, highly mobile, potentially cordless, and available for use at the point of care anywhere at anytime. Enhanced imaging capability of compact machines may one day rival those of the large cart-based machines, and lower prices and user-friendly simplicity will improve accessibility.
If ultrasound is to become an integral part of regional anesthesia, future guidelines and teaching curricula must be established for proper training.
At the present time, teaching resources for ultrasound-guided nerve blocks are limited but atlases, textbooks, and web-based learning materials are forthcoming. Furthermore, the best way to teach has yet to be determined. Ideally, a structured residency teaching curriculum will teach both the cognitive and manual component of the ultrasound-guided technique. Important topics to be covered include equipment selection and functionality, basic ultrasound physics, imaging principles relevant to clinical practice, hands-on scanning skills, sonoanatomy, needling approaches, image interpretation of local anesthetic spread, ultrasound artifacts, and safety issues. Among these topics, visually tracking needle advancement (in-plane and out-of-plane approaches) may be most challenging. Cumulative sum (cusum) analysis has been used to objectively assess resident proficiency in technical anesthesiology procedures. Objective structured assessment of technical skills has also been shown to reliably assess surgical skills using global ratings and task-specific checklists.