Evidence-Based Medicine

Abstract

We performed a systematic search of the medical literature and reviewed the evidence examining success rates and incidence of complications of ultrasound (US) guidance relative to traditional techniques for the following blocks: paravertebral, intercostal, transversus abdominis plane, rectus sheath, and ilioinguinal/iliohypogastric. We included studies of sufficient methodologic quality for review and excluded poor-quality studies. We then rated the strength of evidence for US guidance for each block using a system developed by the United States Agency for Health Care Policy and Research. Although relatively few studies have compared US guidance with established techniques, the available evidence suggests that the use of US guidance is a safe and effective means to facilitate correct needle placement and adequate spread of local anesthetic for truncal blocks. Further studies are needed to directly compare US guidance to traditional techniques and to clarify potential benefits and limitations of US guidance for truncal blocks.

A new neurostimulator guided technique of rectus sheath block: study of feasibility and local anesthetic spread in children

“…In the context of safety in the review of Abrahams et al [8] it is mentioned that US guidance is the preferred method to perform RSB and ilioinguinal/iliohypogastric nerve blocks. On the other hand, safety improvement due to US guidance in regional anesthesia has been demonstrated only for prevention of postoperative neurologic symptoms, vascular puncture, local anesthetic systemic toxicity and hemidiaphragmatic paresis [18].…”

“…Therefore, administration of local anesthetic solution into the potential space between the rectus abdominis muscle and posterior sheath can block innervation of the abdominal midline. Local anesthetic solution can spread along the posterior rectus abdominis muscle sheath cranially and caudally, as tendinous intersections of this muscle are not attached to the posterior sheath [8]. So, depending on local anesthetic volume, the area of anesthesia of the abdominal midline can expand above and below the injection site.…”

“…Usually RSB is performed with ultrasound (US) guidance [8]. Blind RSB technique has been described and used earlier as well [13].…”

The Challenges of Ultrasound-guided Thoracic Paravertebral Blocks in Rib Fracture Patients

“…TPVBs can be placed by landmark-based techniques or with the help of ultrasound (US). Available literature suggests that TPVBs may be performed with a high probability of success using US guidance as an adjunct to traditional techniques [2]. However, there is a paucity of data on the use of real-time US guidance for the TPVBs.…”

“…In fact, due to a lack of studies, Abrahams et al gave a grade B level of evidence recommendation for the use of US to place paravertebral blocks based on two small case series. They further stated that there was insufficient evidence to show that US guidance improved block success rates or reduced the risk of complications compared with traditional techniques for performing single-shot or continuous paravertebral blocks [2].…”