Use of Envision Scanning Pad During an Ultrasound Guided Pecto-intercostal Nerve Block
Arun Kalava, MD, FASA, EDRA
Breakthru Acute Pain & Ketamine Clinic,
Case: Ultrasound Guided Pecto-intercostal Nerve Block
Featured Product: Envision Pad
CONSIDERATION FOR USE
A 42-year-old male veteran presented with severe sternal pain from a sternotomy for an intrathoracic
tumor fifteen years ago. As a result, he suffered from allodynia, or nerve-related skin sensitivity, causing
extreme pain. The patient failed opioid therapy. A spinal cord stimulator was also utilized as a form of
treatment and worked briefly, but it was ultimately removed due to MRSA infection. An ultrasound-guided pecto-intercostal nerve block was the next step in his pain management.
REQUIRED EQUIPMENT FOR EXAMINATION
- SonoSite Edge II ultrasound system, Linear high frequency probe
- CIVCO Envision™ Ultrasound Scanning Pad with sterile saline used as a couplant
ADVANTAGES OF USING ENVISION IN THIS PROCEDURE
- Envision Ultrasound Scanning Pad is sterile.
- Firm grip (non-skid) of the probe over the chest wall, as the chest has uneven surface due to the ribs.
- Increased patient satisfaction and improved clean-up workflow due to not using gel. The patient had extreme sensitivity due to allodynia and wiping of gel may have been more painful.
PATIENT SATISFACTION POST-PROCEDURE
For this patient with chronic post sternotomy pain, the bilateral blocks resulted in 100% pain relief. Ultrasound guidance using the Envision Ultrasound Scanning Pad is currently being utilized to administer phenol and alcohol chemoneurolysis for treatment with variable pain relief of 30-50%.
FIGURE 1. Image of the procedure showing the Envision Ultrasound Scanning Pad on the ultrasound transducer and no gel on the patient’s skin for minimal clean up.
FIGURE 2. Quality ultrasound image showing needle placement