Ultrasound-guided peripheral nerve blocks

Meet the patient

A 55-year-old man arrives for an open reduction of a fractured distal radius. You place a linear probe high in the axilla, identify the cord-like brachial plexus beside the axillary artery, and slide an in-plane needle toward it. A bright halo of local anaesthetic opens around the nerves, the hand goes numb, and the surgeon sets to work on a relaxed, bloodless limb.^[1]

That single block carries the four skills this topic examines: matching the block to the incision, the in-plane discipline of a visible tip, the injection discipline of watched spread at low pressure, and the safety readiness of dose limits, anticoagulation checks and lipid at the bedside. Discipline plus anatomy passes; gadget worship without safety fails.^[1][4]

References10ShowHide

1. [1]Wang ZX, Zhang DL, Liu XW, et al. Efficacy of ultrasound and nerve stimulation guidance in peripheral nerve block: A systematic review and meta-analysis IUBMB Life, 2017.PMID 28714206
2. [2]Neal JM, Neal EJ, Weinberg GL American Society of Regional Anesthesia and Pain Medicine Local Anesthetic Systemic Toxicity checklist: 2020 version Reg Anesth Pain Med, 2021.PMID 33148630
3. [3]Narouze S, Benzon HT, Provenzano D, et al. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain Reg Anesth Pain Med, 2018.PMID 29278603
4. [4]Neal JM, Barrington MJ, Fettiplace MR, et al. The Third American Society of Regional Anesthesia and Pain Medicine Practice Advisory on Local Anesthetic Systemic Toxicity: Executive Summary 2017 Reg Anesth Pain Med, 2018.PMID 29356773
5. [5]Petrar SD, Seltenrich ME, Head SJ, Schwarz SK Hemidiaphragmatic paralysis following ultrasound-guided supraclavicular versus infraclavicular brachial plexus blockade: a randomized clinical trial. Reg Anesth Pain Med, 2015.PMID 25650633
6. [6]Renes SH, Rettig HC, Gielen MJ, et al. Ultrasound-guided low-dose interscalene brachial plexus block reduces the incidence of hemidiaphragmatic paresis. Reg Anesth Pain Med, 2009.PMID 19920426
7. [7]Gao F, Ma J, Sun W, et al. Adductor Canal Block Versus Femoral Nerve Block for Analgesia After Total Knee Arthroplasty: A Systematic Review and Meta-analysis. Clin J Pain, 2017.PMID 27322397
8. [8]Vermeylen K, Hermans M, Soetens F, et al. Opening Injection Pressure Is Higher in Intraneural Compared With Perineural Injections During Simulated Nerve Blocks of the Lower Limb in Fresh Human Cadavers. Reg Anesth Pain Med, 2017.PMID 28092318
9. [9]Lei G, Yang S, Wu L, et al. Intravenous injection of dexamethasone is non-inferior to perineural administration for popliteal sciatic nerve and saphenous nerve blocks: A randomized, controlled, triple-blind study. Heliyon, 2024.PMID 38571656
10. [10]Casas-Arroyave FD, Ramírez-Mendoza E, Ocampo-Agudelo AF Complications associated with three brachial plexus blocking techniques: Systematic review and meta-analysis. Rev Esp Anestesiol Reanim (Engl Ed), 2021.PMID 34294596