The Efficacy and Safety of Ultrasound Guided Peripheral Nerve Blockade A Qualitative Systematic Review

Abstract

The clinical application of regional anesthesia has grown dramatically in recent years in part due to the increasing adoption of ultrasound imaging for peripheral block placement. Ultrasound technology enables real-time visualization of nerves, surrounding structures and local anesthetic spread and therefore offers theoretical advantages over existing methods of nerve localization. This systematic analysis was conducted to assess the current state of evidence for improved block efficacy, safety and other patient related outcomes with ultrasound guided peripheral nerve blockade (UGPNB). A search of the PubMed database was conducted for all randomized controlled trials comparing UGPNB to peripheral blocks performed at the same anatomic site by an alternative method of nerve localization. Forty-four studies, 39 adult and 5 pediatric, were identified for analysis and the results presented in Appendix 1,2,3,4,5. There is increasing Level Ib Grade A evidence that UGPNB, when applied by clinicians with the appropriate skill set, can be performed faster than alternative techniques yielding blocks that are more effective, with quicker onset and longer duration, requiring less local anesthetic, and causing less vascular puncture and greater patient comfort. Improved safety with UGPNB remains largely theoretical due to the low complication rate of all techniques of peripheral nerve block, but there is Level III Grade