An educational guide on the combined use of ultrasound with nerve stimulation as a best practice for nerve location in regional anesthesia is available from medical manufacturer B. Braun.
Dual Guidance: A Multimodal Approach to Nerve Location aims to transform regional anesthesia into a more objective and reproducible discipline than it has been in the past. To obtain a copy, e-mail the company at dualguidance.us@bbraun.com.
"A dual guidance technique affords the anesthesiologist an unprecedented level of understanding and respect for the mysterious needle-to-nerve interaction," says Richard Brull, MD, assistant professor and director of the regional Anesthesia Fellowship Program at the University of Toronto, in the introduction. "Most importantly, it affords the anesthesiologist a higher level of confidence and comfort by drawing on two objective end points — real-time visualization of local anesthetic spread and minimum stimulating threshold current — to predict the likelihood of block success and, possibly, minimize block-related complications."
Nerve stimulation has long been the gold standard for nerve location when performing peripheral nerve blocks, stimulating the nerve and causing the target muscle to twitch. More recently, high-frequency ultrasound imaging has increasingly gained ground as a supplementary or complementary modality, as it lets the anesthesia provider see the nerve and the needle as well as the spread of local anesthesia. Each method offers distinct advantages and limitations.
"It is important for the clinical practitioner to be open to the use of either technique or the combination of the two," says guide contributor William Urmey, MD, attending anesthesiologist at the Hospital for Special Surgery and associate professor of clinical anesthesiology at Weill Cornell Medical College in New York, N.Y. "The use of ultrasound guidance is in its infancy, and we can only hope that it achieves the same high success rate and low complication rate associated with nerve stimulation. Thus far, it has shown great promise."
—Dan O’Connor
