Ultrasound-Guided Regional Anesthesia and Patient Safety

Abstract

The role of ultrasound-guided regional anesthesia (UGRA) in reducing the frequency of regional anesthetic-related complications is difficult to ascertain from analyzing the limited literature on the topic. This evidence-based review critically evaluates the contributions of UGRA to improved patient safety, particularly as compared with standard nerve localization tools. Randomized controlled trials that compared UGRA with another form of neural localization and case series of more than 500 patients were used to compare safety parameters. The quality of studies and strength of evidence were graded. Of those randomized controlled trials identified by our search techniques, 22 compared the incidence of postoperative nerve symptoms, 17 assessed local anesthetic systemic toxicity parameters, and 3 studied hemidiaphragmatic paresis. Statistical proof for meaningful reduction in the frequency of extremely rare complications, such as permanent peripheral nerve injury, is likely unattainable. Although there is evidence for UGRA reducing the occurrence of vascular puncture and the frequency of hemidiaphragmatic paresis, as yet there is at best inconclusive scientific proof that these surrogate outcomes are linked to actual reduction of their associated complications, such as local anesthetic systemic toxicity or predictable diaphragmatic impairment in at-risk individuals. This evidence-based review thus strives to summarize both the power and the limitations of UGRA as a tool for improving patient safety.

Histological confirmation of needle tip position during ultrasound-guided interscalene block: a randomized comparison between the intraplexus and the periplexus approach

“…1,2 This may be due to the limitation of conventional ultrasound to distinguish muscle fascia from epineurium and small fascicles, [3][4][5] such that mechanical nerve injury, barotrauma, or local anesthetic toxicity may result from unintended injection into critical nerve structures. 1,[6][7][8][9][10] This has recently led investigators to focus on how best to avoid nerves while still achieving a reliable block.…”

Epidural Analgesia for Perioperative Upper Abdominal Surgery

“…Exaggerated spinal flexion serves little benefit because thoracic facet joints primarily allow axial rotation. (Neal, 2004) Intravenous sedation (small doses of midazolam and fentanyl) for alleviating anxiety and supplemental oxygen should be given. The assistant should help the patient to hold the position during the entire procedure.…”

An improvised pressure gauge for regional nerve blockade/anesthesia injections: an initial study

“…However, this expectation has not been borne out with systematic reviews [18][19][20], clinical trials [21] and cadaveric studies [22]. Indeed; there are case reports of intraneural injections even with the use of ultrasound [3,16].…”