POC ultrasound for pain management

Point-of-care ultrasound systems are now a common sight throughout the hospital environment, with diagnostic sonography and ultrasound-guided techniques being used routinely in areas as diverse as anaesthetics, paediatrics, emergency medicine, critical care, cardiology, orthopaedics and women’s health. The rapid increase in ultrasound use can be attributed, at least in part, to technological advances in hand-carried ultrasound (HCU) systems, in terms of both usability and image quality. The more user-friendly nature of newer point-of-care systems has made ultrasound accessible to clinicians in a broad spectrum of disciplines, moving basic sonography from the radiology department to the bedside or clinic. Ultrasound-based techniques, such as Focused Assessment with Sonography in Trauma (FAST), in an emergency setting, are now so commonplace that sonography has become a mandatory element of many medical degrees and secondary qualifications. This means that clinicians now coming through the system have a good theoretical grounding in ultrasound usage, further propogating ultrasound use within the clinical setting, leading to an increasing demand for multi-functional hand-carried systems. Anaesthesia was among the first disciplines to embrace the technology, particularly for regional nerve blocks, with a number of anaesthetists switching from nerve stimulator-based techniques to ultrasound needle guidance as access to instruments improves. The increased accuracy of ultrasoundbased techniques has led to significant improvements in the efficacy of the blocks, as well as reducing the time taken to perform them,1,2 however, the versatility of modern hand-carried systems means that ultrasound has now become more than just an alternative to nerve stimulators. It is now routinely used in a variety of pain management strategies, and not just for administration of local anaesthetic.

Post-operative pain management

In many cases the increased accuracy of regional nerve blocks administered under ultrasound needle guidance has resulted in lower volumes of local anaesthetic being required to provide an effective block.3 However, the greater efficacy of ultrasound-guided blocks also provides effective post-operative pain relief, as Dr Christian Egeler, a consultant anaesthetist at Morriston Hospital in Swansea, explains: “Regional blocks allow many procedures to be handled as day surgery cases, avoiding general anaesthetic and the associated side effects. Ultrasound certainly improves the success rates of these blocks, as you can see the needle, the nerve and the spreading anaesthetic during injection. However, the main benefit of ultrasoundguided techniques is post-surgery. The greater efficiency of ultrasound-guided blocks prolongs their effective duration, providing post-operative pain relief for many hours after surgery. Although this type of technique has, until recently, been primarily used for limb surgery, there is now increasing interest in using trunk blocks for major abdominal surgery. While insufficient to provide effective anaesthesia in such cases, these blocks can be used alongside general anaesthetic for analgesia, limiting the patient’s need for morphine-type oral or IV painkillers, and the problems these might cause.”