Technology Produces Images, Helps with Pain Blocks

Many people are familiar with the use of ultrasound imaging in medicine—it’s most commonly used to capture an image of a developing baby in the mother’s womb. But advances in technology and training are enabling physicians to use ultrasound in even more advanced diagnostic and surgical settings.

At NorthBay Healthcare, ultrasound has become a useful tool in applying regional pain blocks and in cardiac diagnostic imaging.

Help Following the Nerves

Jesse Dominguez, M.D., medical director and chief anesthesiologist at NorthBay Medical Center, said ultrasound plays a key role in applying pain blocks during certain surgeries. “If someone is going to have surgery, or comes in with an injury, we think about the pain pathways that surgery or injury will take and strive to block that pain impulse to the brain,” he explained. Epidural or spinal blocks cut off the pain impulse from the spinal cord all the way up to the brain. “It works, but with ultrasound you can now follow the nerves out from the spinal cord and get as close to the injury as possible and block the pain right there.”

The process requires clear and detailed imaging, said Dr. Dominguez, because once a nerve leaves the spinal cord “it has its own path and we have to follow it out.

“We now have the ability to image that nerve using an ultrasound,” he said. “And we have special needles that send a brighter image to the ultrasound… so we are able to put the needle right next to the nerve. Then we can bathe the nerve in local anesthetic to block the pain from that point up to the brain. If we want to have pain control for a longer period, we can insert a catheter, take the needle out and then put in a pump to regulate the pain medicine over time.”

This type of pain blocking can be helpful in recovery following certain surgeries, like those on the knee or ankle, because the pain block can be focused in such a way as to not interfere with certain motor function.

At NorthBay Healthcare, ultrasound has become a useful tool in applying regional pain blocks and in cardiac diagnostic imaging.

Another Special-Tee

One of the most advanced uses of ultrasound at NorthBay involves point-of-care ultrasound of the heart.

Dr. Adam Tibble, a cardiac anesthesiologist at NorthBay Medical Center, regularly uses ultrasound to conduct transesophageal echocardiography (TEE) imaging, getting an inside look at the heart to evaluate its function. “Cardiologists can do this, but at NorthBay I do it and that gives the cardiologists more time to spend with their patients,” Dr. Tibble explained.

Because the esophagus is close by the heart, TEE provides better imaging of the heart.

Dr. Tibble inserts a snake-like ultrasound probe about the size of a pinky finger through the patient’s mouth and down their throat into the esophagus. The doctor has directional control and is able to point the device to capture an image of the beating heart.

“Then I tell the surgeon what we’re seeing. For example, during a valve replacement we can do a pre- and post-surgical report on what it looks like and evaluate the heart function,” he explained.

TEEs can also be done for procedure planning purposes. “I can give the surgeons a heads up of anything I see so they can adjust their operative plan,” said Dr. Tibble. “I can tell if they are looking for a certain size of valve or if a portion of the aorta may need to be replaced.”

Probing the Surface

Ultrasound technology is advancing in other areas of medicine as well. Hand-held surface probes are used in many ways, including in the Emergency Department.

“If a patient comes in from a car wreck with a hole in their lung, you could X-ray the injury but with ultrasound, you get a better image,” explained Dr. Tibble.

Dr. Dominguez agreed. “Now when a patient comes into the Emergency Department, physicians can ultrasound the abdomen to look for free fluid (blood) and determine if surgery is needed,” he said.

What’s driving all these advances? Dr. Dominguez said the answer to that question is three-pronged. “Certainly some of it is because the ultrasound technology is getting better and NorthBay is investing in that advanced technology,” he said. “But also, the tools (the probes and needles) are better. And the third prong is the knowledge base here is growing.”