Does the use of ultrasound guidance improve the safety and efficacy of placing peripheral nerve blocks?

Objectives: Peripheral nerve blocks have traditionally been administered using anatomical landmarks or peripheral nerve stimulation to locate the nerve. The use of ultrasound technology has led to a paradigm shift in practice in the placement of these blocks.

Methods: A literature search was performed using the Cochrane Database of Systematic Reviews and PubMed to locate evidence from peer-reviewed journals comparing the efficacy and safety of using ultrasound technology for placing peripheral nerve blocks.

Results: Five evidence sources met the inclusion criteria including 2 systematic reviews with meta-analysis, 2 systematic reviews without meta-analysis and 1 randomized controlled trial. The evidence reviewed indicated that block success rate was at least as good as with other methods and the incidence of some minor complications reduced. Larger studies are needed to evaluate its effect on major complications. Ultrasound may improve the quality of sensory and motor block, onset time and duration of the block. The success of this particular technique may depend on the expertise of the provider. Future studies should include a larger sample size and adopt a consistent method to assess block success, accuracy and competency of the provider.

Conclusions: Providers should consider adopting ultrasound technology when placing peripheral nerve blocks provided they have adequate education and training with the technology.