Neurostimulation/Ultrasonography: The Trojan War Will Not Take Place

The modern era of regional anesthesia began with a simple needle. Some pioneers believed it was not necessary to have an open surgical field to perform regional blocks; indeed, they were able to demonstrate that it was possible to successfully achieve regional blocks by inserting a needle transcutaneously and searching for paresthesias. Despite positive results, this technique had some major drawbacks, including active patient participation and elicitation of a paresthesia, a sensation that was later shown to be the most unpleasant part of the regional block procedure. Science was injected into the art of regional anesthesia with the advent of neurostimulation. With the development of more reliable equipment and introduction of safer and more effective local anesthetics, needle guidance by neurostimulation enhanced the safety and efficacy of regional anesthesia. More recently, a new method of performing regional block using ultrasound technology has been introduced in clinical practice. Whether ultrasound offers significant advantages over other aids to regional anesthesia represents a central issue in clinical research in the field. In this issue of Anesthesiology, Casati et al. make a substantial contribution to this question, demonstrating that in experienced hands, neurostimulation and ultrasonography have similar success rates and comparable incidences of complications after multiple injection axillary brachial plexus block. Moreover, patient satisfaction was similarly good with both techniques.

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Alain Borgeat, Department of Anesthesiology, Orthopedic University Clinic Balgrist, Zurich, Switzerland. alain.borgeat@balgrist.ch.

Xavier Capdevila, Department of Anesthesiology, Centre Hospitalier Universitaire de Montpellier, Montpellier, France.

Fuente: Anesthesiology: Volume 106(5)May 2007pp 896-898