ULTRASOUND IN PAIN

MANAGEMENT
GUNAPRIYA
RSUP SANGLAH OKTOBER 2019
BLADE HAMMER NEEDLE PROBE

ULTRASOUND IN PAIN MANAGEMENT

 PROBE OPTIONS

• LINEAR ARRAY
• CURVED ARRAY
LOW FREQUENCY

• LOW FREQUENCY (2-3.5 MHZ)

GREATER PENETRATION

LESS RESOLUTION

• DEEP STRUCTURES
AORTA, T/A GYN, CARD, GB, RENAL
HIGH FREQUENCY
• HIGH FREQUENCY (5-10 MHZ)
GREATER RESOLUTION

LESS PENETRATION

• SHALLOW STRUCTURES
VASCULAR, ABSCESS, T/V GYN, TESTICULAR
IMAGE PROPERTIES

• ECHOGENICITY- AMOUNT OF ENERGY REFLECTED BACK FROM TISSUE INTERFACE

• HYPERECHOIC - GREATEST INTENSITY - WHITE

• ANECHOIC - NO SIGNAL - BLACK
• HYPOECHOIC – INTERMEDIATE - SHADES OF GRAY
Hyperechoic Anechoic

Hypoechoic
COLORDOPPLER
ANGLE
STEERING BEAM
ULTRASOUND ORIENTATION
SAX IMAGING

 Most commonly used.

 LAX Imaging

 Rarely used.
SAX OUT OF PLANE (OOP) APPROACH:

Needle is at best seen only in cross section. More commonly,

tissue movement is seen as the needle approaches the target.
 SAX IN PLANE (IP) APPROACH

With this approach, one can see the needle approach the target.
However, be aware that it is easy to be a little oblique, and to not
actually see the needle tip.
OBLIQUE VIEW APPROACH
TECHNIQUE (1)

• IP APPROACH: LINE UP NEEDLE IN MIDDLE OF US PLANE. PENETRATE SKIN AND ENTER UNDER
PROBE. IF NEEDLE NOT SEEN, MOVE PROBE SLIGHTLY AND SLOWLY TO FIND NEEDLE.
MOVING..
TECHNIQUE (2)
• MOVE NEEDLE TO DESIRED LOCATION.
• INJECT 1 ML TO VERIFY NEEDLE LOCATION.
• REPOSITION NEEDLE IF NEEDED.
TECHNIQUE (3)
LOCAL ANESTHETIC SPREAD

• EXAMINE SPREAD OF LOCAL.

• REPOSITION TO NEXT LOCATION IF DESIRED.
SUMMARY

• CHOOSE THE RIGHT FREQUENCY PROBE

• HOLD THE PROBE PERPENDICULAR
• ADJUST THE DEPTH AND GAIN TO HELP YOUR IMAGE
• ARTIFACT MAY BE AFFECTING YOUR IMAGE
TERIMA KASIH
KNEE ULTRASOUND

KETUT NGURAH GUNAPRIYA dr SpAn KIC FIPM FIPP CIPS

MAYAPADA HOSPITAL
PERDOSSI 2002
• 25 % HOSPITAL VISIT • PAIN CLINIC RSU KERTHA USADA
“OUR WELL BEING, IS ONLY FREEDOM FROM PAIN” ( DE
MONTAIGNE.1592)
Every thing I do is to help you
avoid surgery”
PAIN MANAGEMENT
CHRONIC PAIN (POST HERPES NEURALGIA)
ACUTE PAIN (FR CRURIS )
COIN ON THE SAND
AS A SNIPER NOT A BOMBER
LOST IN SPACE
DIAGNOSIS PAIN

• ASAM URAT
• REMATIK
• PENGAPURAN
MSK DIAGNOSIS

• MUSCLE JOINT
• CONTRACTION OVER USE

• RETRACTION WEIGHT BEARING

PAIN IS..

• INFLAMATION

• INNERVATION
TERIMA KASIH