“Imaging” in anestesia loco-regionale e terapia del dolore: ecografia ed epiduroscopia

Abstract

In the last few years imaging techniques have gained importance in locoregional anaesthesia and pain therapy. In locoregional anaesthesia, ultrasound (US) is now used together with electrical nerve stimulation (ENS). In single-shot and continuous peripheral blocks, US allows to achieve higher effectiveness and safety than older techniques (i.e. ENS only, etc.) by reducing local anaesthetic doses. Systemic toxicity risk is also reduced. Notably in orthopaedics, US is considered as the gold standard for peripheral blocks in arthroscopy (i.e. interscalene block, femoral-sciatic nerve block). Epiduroscopy is a surgical technique introduced in pain therapy at the end of the XXth century. The chance to identify and to visualize the causes of chronic lumbar pain is considered as essential in both diagnostic and therapeutic phases. It’s possible to discern between inflammatory areas, neovascularization phenomena, scar tissue and dural abnormalities. Epiduroscopy is a minimally invasive approach: a disposable endoscope is introduced through the sacral iatum and a Fogarty catheter balloon can be used both for diagnostic and therapeutic purposes: it can be used directly on scar tissue to gently cut it under direct visualization. Major indications to epiduroscopy are spinal canal stenosis and FBSS (failed back surgery syndrome).