Equipment

Ultrasound

• most blocks done with linear transducer (15-6MHz)

• for kids/skinny patients, consider using small linear transducer (13-6MHz)

• Some deeper blocks require curvilinear

• phased array transducer generally not used for nerve blocks, more common for TTE

	Small Linear	Large Linear	Hockey Stick	Curvilinear	Phased Array
Image
Usage	Peripheral IV, Arterial Line	Nerve Block, Central Line	Same as “small linear”	Abdominal, Deep Structures	Cardiac

https://www.sonosite.com/products/ultrasound-transducers

In-Plane vs. Out-of-Plane technique

• most nerve blocks done with in-plane technique

• in-plane technically more challenging to align needle tip & target, but can always visualize needle trajectory & tip

http://www.usra.ca/regional-anesthesia/ultrasound-guided-techniques/needlingtechs.php

Single-Shot Block Needles

Pajunk Sonoplex

• thin 21G needles

• short 50mm vs Long 100mm

• more echogenic, can also be used with nerve stimulator

https://pajunkusa.com/products/regional-anesthesia/nerve-blocks/needles/sonoplex-ii/

Catheters

• more time consuming / technically complex procedure

• catheters known to migrate w/ repositioning

• catheters can leak & this is normal

Catheter Over Needle Technique (Pajunk E-Cath)

https://pajunkusa.com/products/regional-anesthesia/nerve-blocks/catheter-sets/e-cath-e-cath-plus/

Catheter Through Needle (Sono-Long)

https://pajunkusa.com/products/regional-anesthesia/nerve-blocks/catheter-sets/sonolong-sono/

Catheter Through Needle (Epidural)

https://pajunkusa.com/products/regional-anesthesia/epidural-caudal/catheter-sets/

Catheter Over Needle vs. Through Needle

• Catheter-over-needle: no gap between skin & catheter, less prone to leaking but still possible. Can seal this with dermabond.

• Catheter-through-needle: after needle withdrawn, small gap around catheter & prone to leakage. Can seal this with dermabond.

https://www.bjanaesthesia.org.uk/article/S0007-0912%2817%2930900-5/fulltext