TRIPLE THREAT Ultrasound can help you reduce or eliminate pain before, during and after surgery.

When it was first suggested that we could use ultrasound for central line insertion, some fought tooth and nail to defend the traditional method: "I have my hands and landmarks, I should use them." Now, of course, ultrasound is mandated in most institutions for central line insertion.

Yet, physicians still occasionally argue against ultrasound's use. Usually, the last step needed to convince them comes when they watch as you insert a line without even looking at the skin. They see on the ultrasound screen as the needle smoothly and elegantly punctures and dives into the vein.

But that's just the beginning. The potential benefits and advantages of ultrasound go beyond what many realize. Along with providing freedom from pain during surgery, ultrasound is helping us ensure a less painful and safer experience both before and after procedures as well. At Memorial Hermann Hospital System in Houston, we've eliminated pneumothorax and almost eradicated incidental lacerations and punctures, in large part because of ultrasound.

Less pain before surgery
Can you provide patients with a pain-free experience, from the intravenous line insertion to the post-operative period? It's what all patients want, after all. An anesthesia team that uses ultrasound can help make the dream a reality.

For the many patients whose veins are difficult to access, ultrasound can help you identify otherwise hidden veins, decreasing the need for multiple painful sticks. We have nursing teams in the hospital that use ultrasound to start longer arm IVs (PICC lines), saving countless patients from the torment of multiple painful needle jabs. With ultrasound, even our most inexperienced physicians can insert central lines, on even our smallest patients, often with patients awake and sedated. It's faster and more effective: One study (tinyurl.com/pjg9yrr) found that ultrasound decreased complications during catheter placement and the need for multiple catheter placement attempts, compared with the standard landmark approach.

Ultrasound is also beneficial for radial artery punctures, especially with obese or vasculopathic patients, who often had to endure the agony of multiple sticks. Now they can usually be easily placed with a single quick needle insertion.

Less pain after surgery
With some procedures, like shoulder and hip surgery, pain can be excruciating after surgery. Here again, ultrasound can make a huge difference. When used to insert blocks for pain relief, and especially when combined with nerve stimulation, it lets us visualize the nerves and surround them with a doughnut of pain-blocking local anesthetic. Doing so doesn't only provide pain relief for 24 hours or more, but by using local anesthetic techniques more often, we can reduce the need for narcotics, which means less nausea and vomiting, and typically greater mobilization of the affected joints.

Rather than argue that we don't need ultrasound, we should be looking for ways to use it that haven't even been discovered yet. For example, in heart surgery, we can now watch the heart with an ultrasound probe placed in the esophagus. With it, we can see heart failure as a swelling or poorly moving heart, we can see dehydration as an empty heart and we can see abnormal movement of the heart, which might indicate a heart attack or heart strain that could lead to damage if it isn't corrected. With 3D ultrasound, we can see an incredibly realistic image of the pumping heart in real time.