Ultrasound-guided spermatic cord block for scrotal surgery

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Ultrasound-guided spermatic cord block for scrotal surgery M Wipfli, F Birkhäuser, C Luyet, R Greif, G Thalmann, U Eichenberger British Journal of Anaesthesia Volume 106, Issue 2, Pages 255-259 (February 2011) DOI: 10.1093/bja/aeq301 Copyright © 2011 The Author(s) Terms and Conditions

Fig 1 This image shows the block technique. The surgeon tightly holds the spermatic cord and lifts it for better visibility of the structures. The ultrasound transducer is applied transversally in relation to the course of the spermatic cord. British Journal of Anaesthesia 2011 106, 255-259DOI: (10.1093/bja/aeq301) Copyright © 2011 The Author(s) Terms and Conditions

Fig 2 The spermatic cord with its contents. The deferent duct is visible as a non-compressible, internal hypoechoic structure with hyperechoic horizon. The venous plexus is not visible due to the compression of the structures with the pinging method as visible in Figure 1. The upper image shows the spermatic cord without Doppler signal. By adding the Doppler signal (lower image), the spermatic artery can be identified and discerned from the deferent duct, which has no flow. The aim is to inject the local anaesthetics into the spermatic cord, close to the deferent duct by avoiding the puncture of the artery. 1, spermatic artery; 2, deferent duct. British Journal of Anaesthesia 2011 106, 255-259DOI: (10.1093/bja/aeq301) Copyright © 2011 The Author(s) Terms and Conditions

Fig 3 Spermatic cord after local anaesthetics (LA) injection. The arrows mark the hypoechoic appearing LA inside the spermatic cord, around, and between the spermatic artery and duct. 1, spermatic artery; 2, deferent duct. British Journal of Anaesthesia 2011 106, 255-259DOI: (10.1093/bja/aeq301) Copyright © 2011 The Author(s) Terms and Conditions

Fig 4 VAS scores at different time points. Baseline, 5 min before block; injection, during injection of the LA; after 15 min, 15 min after the start of surgery; during surgery, mean of VAS scores taken every 30 min until the end of surgery. The box is marked by the first quartile (25th), third quartile (75th), and median. Whiskers show the 10th and the 90th percentiles. Points mark the range. British Journal of Anaesthesia 2011 106, 255-259DOI: (10.1093/bja/aeq301) Copyright © 2011 The Author(s) Terms and Conditions