Ultrasound guidance in peripheral regional anesthesia: philosophy, evidence-based medicine, and techniques.
OBJECTIVE
This article introduces the use of ultrasound to facilitate peripheral regional anesthesia.


RESULTS
Regional anesthesia, despite its well known clinical benefits, has not gained the popularity of general anesthesia. This is secondary to multiple shortcomings including a defined failure rate, lack of simplicity, and the potential for patient discomfort or injury. Many of the negative aspects of regional anesthesia evolve from the reality that current nerve-localization techniques are unreliable. Given the great variation in human anatomy it is not surprising that even the most veteran clinician can be challenged by techniques that demand anatomical assumptions. The recent use of ultrasound imaging for nerve localization is an innovative application of an old technology which addresses many of the shortcomings of current techniques. Specifically, ultrasound imaging allows the operator to see neural structures, guide the needle under real-time visualization, navigate away from sensitive anatomy, and monitor the spread of local anesthetic.


CONCLUSIONS
Ultrasound technology represents an ideal mechanism by which the regional anesthesiologist can attain the safety, speed, and efficacy of general anesthesia. Ultimately, it is the correct peri-neural spread of local anesthetic around a nerve that provides safe, effective, and efficient anesthetic conditions.
Sites
Brian D
BD
Department of Anesthesiology, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. brian.sites@hitchcock.org
Brull
Richard
R
D000765:Anesthesia, Conduction / Q000009:adverse effects / Q000191:economics / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006801:Humans; D007267:Injections; D035002:Lower Extremity / Q000294:innervation; D009407:Nerve Block / Q000009:adverse effects / Q000191:economics / Q000379:methods; D017933:Peripheral Nervous System / Q000000981:diagnostic imaging*; D013997:Time Factors; D020196:Trauma, Nervous System / Q000209:etiology / Q000517:prevention & control; D018084:Ultrasonography, Interventional / Q000191:economics / Q000379:methods; D034941:Upper Extremity / Q000294:innervation
D000779:Anesthetics, Local